Guest guest Posted January 11, 2012 Report Share Posted January 11, 2012 What was done if anything about the renal artery? How was the 70% Dxed? Did anyone hear a bruit over that artery?Have you ever taken BCPs?Don't see any renin aldo numbers?How much salt do you eat?Anyone ever mention DASHing?On Jan 11, 2012, at 11:18 PM, amazingkeltic wrote: Dear Dr. Grim, I am a 64-year-old female. I am a retired surgical heart ICU CCRN. I returned to college at age 39, and obtained a BSN. I also student taught A & P and Micro labs for 12 years post-graduation at Indiana University NW. I relocated to Houston, TX in 2001. During my nursing tenure, I worked in community hospitals and for several prestigious institutions including Methodist Hospital, Texas Medical Center, Houston, for and with DeBakey. I also worked for Hazim Safi's AAA unit at Memorial Hermann while in Houston. I have presented at several critical care consortiums and served as clinical educator at many of the facilities where I worked. So… looking back on this medical journey confounds me. I, of all people, should have done the research and found the answer. I attribute part of this phenomenon to the lack of computer skills. I bought my first computer in 2000. I wasn't what I would consider `computer literate' for a few more years. By this time, I was easily 15 years into my PA odyssey and convinced by professionals I trusted that my right adenoma was just an `incidental' finding and quite common. I pride myself in my knowledge base and assessment skills, but I very clearly dropped the ball when it came to me. I do not hold contempt for the doctors who led me astray. If I couldn't see the writing on the wall, why should they. I will say this, in 20+ years of critical care nursing I never once cared for a patient with PA as a primary or secondary diagnosis and I rarely cared for a patient whose home medications included Spironolactone. Fewer still were prescribed Spiro during their hospitalization. The beginning of the end: I was diagnosed with HTN during a routine screening to begin my nursing clinicals (age 42). The person who diagnosed it was an itty bitty nun who was about 104. Poor thing could barely inflate the cuff. Her first reading: 170/104. I assumed the extended inflation time had something to do with it and asked that she repeat it. She did. No change. The doctor that followed confirmed the DX. Begin the litany of BP meds dispensed so conservatively, I am surprised I didn't stroke while waiting. Every change that was made required a waiting period and another visit. Finally, a few years in, I showed some progress. BPs were generally 140-150's/80-90's and that was on a good day. The doc took the standard approach: started with a diuretic then added a CCB, ACE, and finally a b-blocker. See attachment for current medications. The b-blocker was Labetalol. When this was added (due to the alpha blocking), I completely stopped have the adrenalin rushes I had for years – so the offender was nor-epi and not epi? But this created an anti-depressant dilemma: block it with one med, then hold it in the synapse with another… hmmmm… the old come here, go away therapy. Any suggestions because I am on both currently? From age 19 until my diagnosis and treatment for clinical depression in 1985, I had repeated episodes of depression, anxiety attacks, panic attacks, even agoraphobia. When I was finally diagnosed, I was put on Doxepin and have taken it intermittently since that time. My history includes severe child abuse and molestation. So what do I do after I escaped? I, in essence, married my father and the abuse and stress continued. I just kept throwing more logs on the fire. I therefore attributed much of what I was experiencing to my history. I assumed my resistant pressures were anxiety-driven. During this time, I could feel the release of adrenalin. It hit my chest like 360joules. Then the panic and anxiety would ensue. After reading The Evolution, I see that psycho-social stress can produce adenomas. Huge ah-ha moment for this critical care RN. During this time, I suggested a possible pheochromocytoma diagnosis. With the uncontrollable HTN and added microhematuria and mild proteinuria I was beginning to have real concerns. Docs weren't buying that. Too rare. About as rare as PA. But I kept pushing so they started chasing a Lupus diagnosis. The ANA was negative and I was pronounced well, except for the psych issues <sigh>. After graduation (1992), I went to work in a community hospital med/surg ICU. At the same time, we moved and began building the `dream house' we could now afford. My four children were struggling to assimilate into a new environment and school. My oldest daughter was living with us with her baby while her husband served in Desert Storm. All four burners were full up and it wasn't long before I began floundering. One night I went to bed. It felt like me HR was about 200 and I could feel the PVCs. Each one made a pronounce thud in my chest followed by a momentary brain haze. It got so intense I finally asked my husband to take me to the ER. My potassium was 2.7. Their treatment of cure was 20mEq of effervescent potassium po and serial labs. I was released when my K+ hit 3.3. I was pronounced well and they sent me on my way. I scheduled an appointment with my doctor who was still not connecting the dots. He did add 20mEq of K+ daily to my meds. Things stayed pretty much the same. On anti-depressants, then off, uncontrolled HTN, micro hematuria, mild proteinuria, panic, anxiety off and on, same stuff that everyone now considered my normal. We built the house, kids were leaving one-by-one and the marriage had run its course. Divorce was inevitable. During this period, I developed `severe' right flank pain. It felt like if I could stick my finger inside my body up to my hand at the level of my inferior rib, I could touch where the pain was located. Now I get it. My doctor gave me some Vicodin which helped but I was miserable, couldn't find a comfortable position and it went on for 2 months. At that time he ordered a CT of my chest. God only knows why. The right adrenal adenoma (or nodule as it was described) was uncovered. Still not connecting the dots, him or me. That year I divorced and relocated to Houston. I was happier and felt healthier. I was even able to wean down my anti-hypertensives. This is when the issues with my back began and the introduction of daily NSAIDs. It is now a concern for me because I know there is an issue with combining NSAIDs and Spiro. Your thoughts? More life changes. I moved back to Chicago October 2004 and decided to give my failed marriage a second chance. It was less stressful than it had been, but still acceptable. Soon, I started having a lot of PVCs again. I was at work one night and decided to run a strip to see if these were PACs of PVCs. They were PVCs (bigeminy, trigeminy, and random). I had a nurse friend draw some blood and we sent it to lab. My potassium was 2.8. I called the pharmacy and they sent me 100 mEq of K+. It suppressed the PVCs for a few days but they returned. Again, I ran a strip, drew blood, K+ was 3.0. Sent for a supplement and went to the clinic. The doctor I had always seen left the Clinic, so I no longer had a doctor. An Immediate Care physician saw me. He ordered a 24-hr Holter and labs. The PVCs were ridiculously high. I know. I could feel every one. But nothing was done. No follow-up, consultations, referrals, or treatment. Things were deteriorating rapidly with the current living situation, so I moved out. I began having severe lower leg and feet cramps in 2008. I also was having frequent lower leg fasciculations, particularly when I'd lay down. I started taking B12 for the cramping which helped quite a bit. In January 2009 I moved to polis, MD to take a job at s Hopkins. A death in the family brought me home again in October 2009. I retired and it's been downhill ever since. Being uninsured until July 2012 (Medicare), I was seeing a NP at a local doc-in-a-box to get my prescriptions. I started having days filled with PVCs and depression. I was started back on Doxepin. Labs showed my potassium to be in the 3.0 to 3.2 range, a level that makes me symptomatic. Knowing the cause, I finally just started treating it myself, usually 80-120mEq over a day and a half and I would be okay for a couple of weeks. It was during this time that it registered how often I was urinating. It was so much that I finally bought a meter to check my BS. It was and is normal as is my A1C. I needed a higher level of care so I started seeing the PA at the doc-in-a-box thinking she would be consulting with the in-house doctor regarding my care. After the initial appointment, I was told they would no longer prescribe the Doxepin. The doctor thought I was taking it for sleep or selling it, not sure which. I also needed medication refills. The potassium called in was ½ my normal dose. I freaked because I was almost out and having PVCs again. So I gathered my history `evidence' and took it to the PA. She refused to prescribe the correct amount after I told her I was self-medicating and why with the proof in hand. After an embarrassing tete tete occurring in front of staff and a waiting room full of patients, I stormed out. I asked a friend pull a few strings (doctors won't see you if you're a self-pay I've discovered) and I got in to see a family practice doc in September 2011. Rather than have a staff member record my history incorrectly, I put it in H & P format and handed it to the doctor. While preparing the document, I decided to do some research on the causes of chronic low potassium other than the obvious (thiazide diuretic, albuterol inhaler, and recent rounds of prednisone for pneumonia). Imagine my surprise when Conn's popped up and I finally connected the dots. I am THE POSTER CHILD for Stage IV Conn's. When I had my appointment with the family practice doc, I said, "The bilateral adrenal adenomas are probably functional and it is highly likely that I have Conn's Syndrome". I told him about the low potassium, my symptoms, and how I had been treating it. Much to my surprise and without labs to back up my claim, he prescribed K+ supplements equal to my bi-tri-weekly fix. However, no PA blood or urine labs were ordered and his primary concern was the right renal artery stenosis. The way I viewed that: if my aorta showed calcification in 2000, it is highly likely that the renal artery is also calcified. I thought that was probable because I have been mildly hypercalcemic for years. That I attributed to higher blood calcium levels secondary to CCB therapy. Now I am not so sure. I do have a question: In your Evolution article you state that one of the symptoms of the 34-year-old female was a positive Chevostek and Trousseau. Aren't those tests reflective of low blood calcium? Also, my lab abnormalities are often part of the earth metal/alkaline earth metal periodic family. Is there a correlation other than the valence numbers? Also, a few days a month about an hour after I take my meds, I start feeling light-headed and strange. I know now that the feeling is related to bradycardia and hypotension (HR 50's, BP 80's/30-40's). As the half-life decreases the circulating levels, my HR and BP began looking like my baseline (HR 70's, BP 140-150/80-90). When I feel that way, my radial pulse is almost not palpable. Laying down, of course, helps. So, now I am thinking that, on those days, my aldosterone is suppressed. Am I right? Another thing: Around 2003-4 or so, we started using Nesiritide (atrial natriuretic – ANH stimulator) instead of Dobutrex and Primacor for our CHFers. In the Evolution article, you say that increased vascular pressures promotes natriuresis. So, it follows that these patients have decompensated and no longer respond to the body's compensatory mechanism, correct? Also, does this have something to do with the push for ACE inhibitors as the lead medication in treating HTN? One more question: I am post-menopausal but did have night sweats before menopause that I attributed to hormone levels. I still have night sweats but these are different. I wake up about every two hours. At first I feel almost afraid, my heart starts racing, then I feel completely strange, then I get really hot. The onset of another symptom ends the prior symptom. I've timed it from the fear feeling to the end. It lasts about 4-5 minutes. Then everything returns to normal. This happens most nights sometimes every two hours all night It even happens when I nap. It is what wakes me up. I researched the symptoms and was thinking there was a correlation to LH and FSH based on the q 2 hour cycle. I also considered a release of cortisol. Now I wonder if it is part and parcel of the PA. Any thoughts? Is aldosterone released in intervals? If so, what's the time frame? Finally, of the Stage IV symptoms, these are the ones I've experienced: profound hypokalemia, polyuria, drug resistant HTN, hand/feet/leg cramps, profound weakness, periodic paralysis (onset when I stand but then it subsides in a couple of minutes), arrhythmias, mild proteinuria, and alkaline urine. There is so much more I am probably leaving out, but I am sure you will ask the questions that will free that information. So, thank you for your time and consideration. I'm looking forward to the journey. Barbara Tatro Medical History 1. Hypertension – DX 1989 - age 42 – Severe and resistant since DX 2. Right Renal Artery Stenosis (70%) – 2009 3. Atrophic right kidney 4. Adrenal adenoma – Left 2.2 x 2.5; Right 2.1 x 1.2 Right diagnosed 2-2000 (1.5); Left diagnosed 6-2009 and increased size of right adenoma (described as adrenal nodules) 5. Hypokalemia (profound – 1st incidence 1991, documented 2008-2011) 6. Mild hypercalcemia 7. Hypomagnesemia 8. Micro hematuria (small) 9. Mild proteinuria 10. Aortic calcification 11. Heat Intolerance 12. Back – T11-12 Central disc extrusion, mild central canal stenosis; L1-2 bulging disc with compression of thecal sac; L2-3 bulging disc compressing thecal sac; L3-4 bulging disc, retroliathesis, central canal stenosis biforaminal stenosis; L4-5 unroofed disc, spondyloliatheses, severe central canal and biforaminal stenosis; L5-S1 extruded disc, left and right foraminal stenosis 13. Left hip – joint space narrowing and arthritic changes, subchondral sclerosis (rheumatoid v. osteoarthritis) 14. Left lateral leg neuropathy with atrophy 15. Falling 16. Pneumonia – February, May, September 2011 17. Bilateral otitis media – February, May, September 2011 18. COPD 19. HPV 20. GI bleed – Diffuse gastritis – 2002 secondary to NSAID therapy 21. Fuch's Corneal Dystrophy (left eye severe, right eye mild to moderate) 22. Basal cell carcinoma left cheek 23. Adenomyosis – D & C x 3 1970's 24. Fractures – right tibia, left thumb, spiral fracture right 4th toe 25. Seasonal allergies 26. Chronic pain 27. Depression, anxiety and panic attacks, `nervous breakdown' x3 – first at age 19 – about every 10 years thereafter – last one 1985 28. Severe childhood abuse and molestation 29. Smoker 1ppd x 40 years Surgeries 1. Exploratory lap, choleycystectomy - 1977 2. Hysteroscopy – 1995 3. Removal basal cell carcinoma left cheek – 2000 Family History 1. Father (deceased) – CHF, multiple MI, multiple CVA, Resistant HTN, Fuch's Corneal Dystrophy, depression, HOH 2. Mother (deceased) – HTN, cervical cancer, metastatic cancer 3. Sister (68) – Fuch's corneal dystrophy, depression 4. Brother (66) – Bladder cancer, thyroid cancer, HTN, Type II Diabetes, depression 5. Brother (60) – HTN, Depression, dysrhythmia 6. Brother (46) - Dysrhythmia, depression Allergies 1. Serotonin – Seizure, anaphylaxis, Serotonin Syndrome (ER x3) 2. Levaquin – Levaquin Syndrome 3. Wellbutrin – Cardiac dysrhythmia Prevention 1. Flu vaccine 11/2012 2. Pneumonia vaccine 11/2010 Medications December - 2011 1. Lisinopril-Hctz 20/12.5 mg BID 2. Verapamil 120mg BID 3. Labetalol 200mg BID 4. Pravastatin 20mg Q night 5. Doxepin 75mg QD 6. ASA 81mg BID 7. Potassium 20 mEq BID 8. Doxepin 75 mg QD 9. Ibuprofen 800mg BID 10. Zyrtec 10 mg QD 11. Glucosam/Chon 1500/1200mg QD 12. Vit B12 1000mcg QD 13. Vit C 500mg QD 14. Magnesium 250mg BID 15. Multi-Vit 1 tab QD 16. Fish Oil 1000 mg BID 17. Ventolin Inhale 1-2 puffs PRN 18. Naproxen 440mg PRN Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 12, 2012 Report Share Posted January 12, 2012 Hi, Thanks for the speedy reply. Stenosis was Dx'd June 2009. All that was done was a US of the renal arteries (DX % in terms of velocity). Within a month, I was moving. No follow-up because I retired and was uninsured. Medicare begins July 2012. The family practice doctor I am now seeing wanted this assessed by vascular. I can't afford that until Medicare kicks in. I will see vascular then. No one listened for a bruit, even my aorta which has been calcified for years. Took BCPs for about 2 months in my early 30's. I diagnosed the PA. No one else has ever even suggested it, therefore, no aldo numbers. Salt intake: Was probably average. I am now doing Weight Watchers and have altered my diet to include mostly fresh or steamed veggies, fresh fruit, flat bread, light cream cheese, canned or smoked fish, water, etc. My salt intake now is probably consistent with DASH. I looked it over and it is pretty close to the diet I've constructed for myself and that I find remarkably easy to follow. No one has ever mentioned DASHing. Why would they. Everybody is in bed with everyone else. If you fix what ails you with diet, how will the doctors and big drug companies get rich? Barbara Re: History/Story What was done if anything about the renal artery? How was the 70% Dxed? Did anyone hear a bruit over that artery? Have you ever taken BCPs? Don't see any renin aldo numbers? How much salt do you eat? Anyone ever mention DASHing? On Jan 11, 2012, at 11:18 PM, amazingkeltic wrote: Dear Dr. Grim,I am a 64-year-old female. I am a retired surgical heart ICU CCRN. I returned to college at age 39, and obtained a BSN. I also student taught A & P and Micro labs for 12 years post-graduation at Indiana University NW. I relocated to Houston, TX in 2001. During my nursing tenure, I worked in community hospitals and for several prestigious institutions including Methodist Hospital, Texas Medical Center, Houston, for and with DeBakey. I also worked for Hazim Safi's AAA unit at Memorial Hermann while in Houston. I have presented at several critical care consortiums and served as clinical educator at many of the facilities where I worked. So… looking back on this medical journey confounds me. I, of all people, should have done the research and found the answer. I attribute part of this phenomenon to the lack of computer skills. I bought my first computer in 2000. I wasn't what I would consider `computer literate' for a few more years. By this time, I was easily 15 years into my PA odyssey and convinced by professionals I trusted that my right adenoma was just an `incidental' finding and quite common. I pride myself in my knowledge base and assessment skills, but I very clearly dropped the ball when it came to me.I do not hold contempt for the doctors who led me astray. If I couldn't see the writing on the wall, why should they. I will say this, in 20+ years of critical care nursing I never once cared for a patient with PA as a primary or secondary diagnosis and I rarely cared for a patient whose home medications included Spironolactone. Fewer still were prescribed Spiro during their hospitalization. The beginning of the end: I was diagnosed with HTN during a routine screening to begin my nursing clinicals (age 42). The person who diagnosed it was an itty bitty nun who was about 104. Poor thing could barely inflate the cuff. Her first reading: 170/104. I assumed the extended inflation time had something to do with it and asked that she repeat it. She did. No change. The doctor that followed confirmed the DX. Begin the litany of BP meds dispensed so conservatively, I am surprised I didn't stroke while waiting. Every change that was made required a waiting period and another visit. Finally, a few years in, I showed some progress. BPs were generally 140-150's/80-90's and that was on a good day. The doc took the standard approach: started with a diuretic then added a CCB, ACE, and finally a b-blocker. See attachment for current medications. The b-blocker was Labetalol. When this was added (due to the alpha blocking), I completely stopped have the adrenalin rushes I had for years – so the offender was nor-epi and not epi? But this created an anti-depressant dilemma: block it with one med, then hold it in the synapse with another… hmmmm… the old come here, go away therapy. Any suggestions because I am on both currently?From age 19 until my diagnosis and treatment for clinical depression in 1985, I had repeated episodes of depression, anxiety attacks, panic attacks, even agoraphobia. When I was finally diagnosed, I was put on Doxepin and have taken it intermittently since that time. My history includes severe child abuse and molestation. So what do I do after I escaped? I, in essence, married my father and the abuse and stress continued. I just kept throwing more logs on the fire. I therefore attributed much of what I was experiencing to my history. I assumed my resistant pressures were anxiety-driven. During this time, I could feel the release of adrenalin. It hit my chest like 360joules. Then the panic and anxiety would ensue. After reading The Evolution, I see that psycho-social stress can produce adenomas. Huge ah-ha moment for this critical care RN. During this time, I suggested a possible pheochromocytoma diagnosis. With the uncontrollable HTN and added microhematuria and mild proteinuria I was beginning to have real concerns. Docs weren't buying that. Too rare. About as rare as PA. But I kept pushing so they started chasing a Lupus diagnosis. The ANA was negative and I was pronounced well, except for the psych issues <sigh>.After graduation (1992), I went to work in a community hospital med/surg ICU. At the same time, we moved and began building the `dream house' we could now afford. My four children were struggling to assimilate into a new environment and school. My oldest daughter was living with us with her baby while her husband served in Desert Storm. All four burners were full up and it wasn't long before I began floundering. One night I went to bed. It felt like me HR was about 200 and I could feel the PVCs. Each one made a pronounce thud in my chest followed by a momentary brain haze. It got so intense I finally asked my husband to take me to the ER. My potassium was 2.7. Their treatment of cure was 20mEq of effervescent potassium po and serial labs. I was released when my K+ hit 3.3. I was pronounced well and they sent me on my way.I scheduled an appointment with my doctor who was still not connecting the dots. He did add 20mEq of K+ daily to my meds. Things stayed pretty much the same. On anti-depressants, then off, uncontrolled HTN, micro hematuria, mild proteinuria, panic, anxiety off and on, same stuff that everyone now considered my normal.We built the house, kids were leaving one-by-one and the marriage had run its course. Divorce was inevitable. During this period, I developed `severe' right flank pain. It felt like if I could stick my finger inside my body up to my hand at the level of my inferior rib, I could touch where the pain was located. Now I get it. My doctor gave me some Vicodin which helped but I was miserable, couldn't find a comfortable position and it went on for 2 months. At that time he ordered a CT of my chest. God only knows why. The right adrenal adenoma (or nodule as it was described) was uncovered. Still not connecting the dots, him or me. That year I divorced and relocated to Houston. I was happier and felt healthier. I was even able to wean down my anti-hypertensives. This is when the issues with my back began and the introduction of daily NSAIDs. It is now a concern for me because I know there is an issue with combining NSAIDs and Spiro. Your thoughts?More life changes. I moved back to Chicago October 2004 and decided to give my failed marriage a second chance. It was less stressful than it had been, but still acceptable. Soon, I started having a lot of PVCs again. I was at work one night and decided to run a strip to see if these were PACs of PVCs. They were PVCs (bigeminy, trigeminy, and random). I had a nurse friend draw some blood and we sent it to lab. My potassium was 2.8. I called the pharmacy and they sent me 100 mEq of K+. It suppressed the PVCs for a few days but they returned. Again, I ran a strip, drew blood, K+ was 3.0. Sent for a supplement and went to the clinic. The doctor I had always seen left the Clinic, so I no longer had a doctor. An Immediate Care physician saw me. He ordered a 24-hr Holter and labs. The PVCs were ridiculously high. I know. I could feel every one. But nothing was done. No follow-up, consultations, referrals, or treatment.Things were deteriorating rapidly with the current living situation, so I moved out. I began having severe lower leg and feet cramps in 2008. I also was having frequent lower leg fasciculations, particularly when I'd lay down. I started taking B12 for the cramping which helped quite a bit. In January 2009 I moved to polis, MD to take a job at s Hopkins. A death in the family brought me home again in October 2009. I retired and it's been downhill ever since. Being uninsured until July 2012 (Medicare), I was seeing a NP at a local doc-in-a-box to get my prescriptions. I started having days filled with PVCs and depression. I was started back on Doxepin. Labs showed my potassium to be in the 3.0 to 3.2 range, a level that makes me symptomatic. Knowing the cause, I finally just started treating it myself, usually 80-120mEq over a day and a half and I would be okay for a couple of weeks. It was during this time that it registered how often I was urinating. It was so much that I finally bought a meter to check my BS. It was and is normal as is my A1C.I needed a higher level of care so I started seeing the PA at the doc-in-a-box thinking she would be consulting with the in-house doctor regarding my care. After the initial appointment, I was told they would no longer prescribe the Doxepin. The doctor thought I was taking it for sleep or selling it, not sure which. I also needed medication refills. The potassium called in was ½ my normal dose. I freaked because I was almost out and having PVCs again. So I gathered my history `evidence' and took it to the PA. She refused to prescribe the correct amount after I told her I was self-medicating and why with the proof in hand. After an embarrassing tete tete occurring in front of staff and a waiting room full of patients, I stormed out. I asked a friend pull a few strings (doctors won't see you if you're a self-pay I've discovered) and I got in to see a family practice doc in September 2011. Rather than have a staff member record my history incorrectly, I put it in H & P format and handed it to the doctor. While preparing the document, I decided to do some research on the causes of chronic low potassium other than the obvious (thiazide diuretic, albuterol inhaler, and recent rounds of prednisone for pneumonia). Imagine my surprise when Conn's popped up and I finally connected the dots. I am THE POSTER CHILD for Stage IV Conn's. When I had my appointment with the family practice doc, I said, "The bilateral adrenal adenomas are probably functional and it is highly likely that I have Conn's Syndrome". I told him about the low potassium, my symptoms, and how I had been treating it. Much to my surprise and without labs to back up my claim, he prescribed K+ supplements equal to my bi-tri-weekly fix. However, no PA blood or urine labs were ordered and his primary concern was the right renal artery stenosis. The way I viewed that: if my aorta showed calcification in 2000, it is highly likely that the renal artery is also calcified. I thought that was probable because I have been mildly hypercalcemic for years. That I attributed to higher blood calcium levels secondary to CCB therapy. Now I am not so sure.I do have a question: In your Evolution article you state that one of the symptoms of the 34-year-old female was a positive Chevostek and Trousseau. Aren't those tests reflective of low blood calcium? Also, my lab abnormalities are often part of the earth metal/alkaline earth metal periodic family. Is there a correlation other than the valence numbers?Also, a few days a month about an hour after I take my meds, I start feeling light-headed and strange. I know now that the feeling is related to bradycardia and hypotension (HR 50's, BP 80's/30-40's). As the half-life decreases the circulating levels, my HR and BP began looking like my baseline (HR 70's, BP 140-150/80-90). When I feel that way, my radial pulse is almost not palpable. Laying down, of course, helps. So, now I am thinking that, on those days, my aldosterone is suppressed. Am I right?Another thing: Around 2003-4 or so, we started using Nesiritide (atrial natriuretic – ANH stimulator) instead of Dobutrex and Primacor for our CHFers. In the Evolution article, you say that increased vascular pressures promotes natriuresis. So, it follows that these patients have decompensated and no longer respond to the body's compensatory mechanism, correct? Also, does this have something to do with the push for ACE inhibitors as the lead medication in treating HTN?One more question: I am post-menopausal but did have night sweats before menopause that I attributed to hormone levels. I still have night sweats but these are different. I wake up about every two hours. At first I feel almost afraid, my heart starts racing, then I feel completely strange, then I get really hot. The onset of another symptom ends the prior symptom. I've timed it from the fear feeling to the end. It lasts about 4-5 minutes. Then everything returns to normal. This happens most nights sometimes every two hours all night It even happens when I nap. It is what wakes me up. I researched the symptoms and was thinking there was a correlation to LH and FSH based on the q 2 hour cycle. I also considered a release of cortisol. Now I wonder if it is part and parcel of the PA. Any thoughts? Is aldosterone released in intervals? If so, what's the time frame?Finally, of the Stage IV symptoms, these are the ones I've experienced: profound hypokalemia, polyuria, drug resistant HTN, hand/feet/leg cramps, profound weakness, periodic paralysis (onset when I stand but then it subsides in a couple of minutes), arrhythmias, mild proteinuria, and alkaline urine.There is so much more I am probably leaving out, but I am sure you will ask the questions that will free that information. So, thank you for your time and consideration. I'm looking forward to the journey.Barbara TatroMedical History1. Hypertension – DX 1989 - age 42 – Severe and resistant since DX2. Right Renal Artery Stenosis (70%) – 20093. Atrophic right kidney4. Adrenal adenoma – Left 2.2 x 2.5; Right 2.1 x 1.2 Right diagnosed 2-2000 (1.5); Left diagnosed 6-2009 and increased size of right adenoma (described as adrenal nodules)5. Hypokalemia (profound – 1st incidence 1991, documented 2008-2011)6. Mild hypercalcemia7. Hypomagnesemia8. Micro hematuria (small)9. Mild proteinuria10. Aortic calcification11. Heat Intolerance12. Back – T11-12 Central disc extrusion, mild central canal stenosis; L1-2 bulging disc with compression of thecal sac; L2-3 bulging disc compressing thecal sac; L3-4 bulging disc, retroliathesis, central canal stenosis biforaminal stenosis; L4-5 unroofed disc, spondyloliatheses, severe central canal and biforaminal stenosis; L5-S1 extruded disc, left and right foraminal stenosis13. Left hip – joint space narrowing and arthritic changes, subchondral sclerosis (rheumatoid v. osteoarthritis)14. Left lateral leg neuropathy with atrophy15. Falling16. Pneumonia – February, May, September 201117. Bilateral otitis media – February, May, September 201118. COPD19. HPV20. GI bleed – Diffuse gastritis – 2002 secondary to NSAID therapy21. Fuch's Corneal Dystrophy (left eye severe, right eye mild to moderate)22. Basal cell carcinoma left cheek 23. Adenomyosis – D & C x 3 1970's24. Fractures – right tibia, left thumb, spiral fracture right 4th toe25. Seasonal allergies26. Chronic pain27. Depression, anxiety and panic attacks, `nervous breakdown' x3 – first at age 19 – about every 10 years thereafter – last one 198528. Severe childhood abuse and molestation29. Smoker 1ppd x 40 yearsSurgeries1. Exploratory lap, choleycystectomy - 19772. Hysteroscopy – 19953. Removal basal cell carcinoma left cheek – 2000Family History1. Father (deceased) – CHF, multiple MI, multiple CVA, Resistant HTN, Fuch's Corneal Dystrophy, depression, HOH2. Mother (deceased) – HTN, cervical cancer, metastatic cancer 3. Sister (68) – Fuch's corneal dystrophy, depression4. Brother (66) – Bladder cancer, thyroid cancer, HTN, Type II Diabetes, depression5. Brother (60) – HTN, Depression, dysrhythmia6. Brother (46) - Dysrhythmia, depressionAllergies1. Serotonin – Seizure, anaphylaxis, Serotonin Syndrome (ER x3)2. Levaquin – Levaquin Syndrome3. Wellbutrin – Cardiac dysrhythmiaPrevention1. Flu vaccine 11/20122. Pneumonia vaccine 11/2010Medications December - 20111. Lisinopril-Hctz 20/12.5 mg BID2. Verapamil 120mg BID3. Labetalol 200mg BID 4. Pravastatin 20mg Q night5. Doxepin 75mg QD6. ASA 81mg BID7. Potassium 20 mEq BID8. Doxepin 75 mg QD9. Ibuprofen 800mg BID10. Zyrtec 10 mg QD11. Glucosam/Chon 1500/1200mg QD12. Vit B12 1000mcg QD13. Vit C 500mg QD14. Magnesium 250mg BID15. Multi-Vit 1 tab QD16. Fish Oil 1000 mg BID17. Ventolin Inhale 1-2 puffs PRN18. Naproxen 440mg PRN Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 12, 2012 Report Share Posted January 12, 2012 Hi Barbara and welcome! Your story sounds quite complete and unfortuntely quite the norm around here! I can't tell you how many professionals I've introduced PA to! The other day I had a PFT to see what changes were evident with PA under control. I was DXed w/COPD and on F/T supplemental oxygen for 16 months. I saw a newly hired technician and she was quite surprised that I no longer needed it. She just happened to be reviewing her notes on the adrenal! I explained the low oxygen was caused by LVH which corrected at 12 weeks after getting PA under control! (Next PTN was delayed 20 minutes because she wanted to know all bout PA!) I really wanted to talk about flank pain. That is what finally ended up getting me DXed w/PA, unfortunately that was a 5 year process! (I've had HTN since I was in my 30's, always DXed as W/C syndrome and stress!) In 2005 I suddenly developed rt. flank pain. Every time anyone asked where I pointed to my rt. kidney and it radiated to my rt. testis. They found 2 stones and we watched them until we decided they weren't the cause. They put me on methdone and oxycodone and I was medically retired, for some reason they don't want you driving a tour bus on those drugs! The pain and all symptoms of PA went away in 2010 when I got NA low enough to let spiro work. Many doctors told me " that little tumor " would not be causing the pain, they are probably correct - it was the excess aldosterone! I have recently started washing spiro to prepare for an AVS. After about a week off spiro the pain came back so there are the results of a trial of one - hope it helps! - 65 yo super ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank pain. Treating with DASH. Stats w/o meds = BP 175/90 HR 59 BS 125. D/C Spironolactone 12/20/2011 due to adverse SX. Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, Gynecomastia, MDD and PTSD. Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin and Metformin 2000MG. Started washing Spironolactone 12/20/11 to prepare for AVS. > > Dear Dr. Grim, > > I am a 64-year-old female. I am a retired surgical heart ICU CCRN. I returned to college at age 39, and obtained a BSN. I also student taught A & P and Micro labs for 12 years post-graduation at Indiana University NW. I relocated to Houston, TX in 2001. During my nursing tenure, I worked in community hospitals and for several prestigious institutions including Methodist Hospital, Texas Medical Center, Houston, for and with DeBakey. I also worked for Hazim Safi's AAA unit at Memorial Hermann while in Houston. I have presented at several critical care consortiums and served as clinical educator at many of the facilities where I worked. > > So… looking back on this medical journey confounds me. I, of all people, should have done the research and found the answer. I attribute part of this phenomenon to the lack of computer skills. I bought my first computer in 2000. I wasn't what I would consider `computer literate' for a few more years. By this time, I was easily 15 years into my PA odyssey and convinced by professionals I trusted that my right adenoma was just an `incidental' finding and quite common. I pride myself in my knowledge base and assessment skills, but I very clearly dropped the ball when it came to me. > > I do not hold contempt for the doctors who led me astray. If I couldn't see the writing on the wall, why should they. I will say this, in 20+ years of critical care nursing I never once cared for a patient with PA as a primary or secondary diagnosis and I rarely cared for a patient whose home medications included Spironolactone. Fewer still were prescribed Spiro during their hospitalization. > > The beginning of the end: I was diagnosed with HTN during a routine screening to begin my nursing clinicals (age 42). The person who diagnosed it was an itty bitty nun who was about 104. Poor thing could barely inflate the cuff. Her first reading: 170/104. I assumed the extended inflation time had something to do with it and asked that she repeat it. She did. No change. The doctor that followed confirmed the DX. Begin the litany of BP meds dispensed so conservatively, I am surprised I didn't stroke while waiting. Every change that was made required a waiting period and another visit. Finally, a few years in, I showed some progress. BPs were generally 140-150's/80-90's and that was on a good day. The doc took the standard approach: started with a diuretic then added a CCB, ACE, and finally a b-blocker. See attachment for current medications. The b-blocker was Labetalol. When this was added (due to the alpha blocking), I completely stopped have the adrenalin rushes I had for years – so the offender was nor-epi and not epi? But this created an anti-depressant dilemma: block it with one med, then hold it in the synapse with another… hmmmm… the old come here, go away therapy. Any suggestions because I am on both currently? > > From age 19 until my diagnosis and treatment for clinical depression in 1985, I had repeated episodes of depression, anxiety attacks, panic attacks, even agoraphobia. When I was finally diagnosed, I was put on Doxepin and have taken it intermittently since that time. My history includes severe child abuse and molestation. So what do I do after I escaped? I, in essence, married my father and the abuse and stress continued. I just kept throwing more logs on the fire. I therefore attributed much of what I was experiencing to my history. I assumed my resistant pressures were anxiety-driven. During this time, I could feel the release of adrenalin. It hit my chest like 360joules. Then the panic and anxiety would ensue. After reading The Evolution, I see that psycho-social stress can produce adenomas. Huge ah-ha moment for this critical care RN. > > During this time, I suggested a possible pheochromocytoma diagnosis. With the uncontrollable HTN and added microhematuria and mild proteinuria I was beginning to have real concerns. Docs weren't buying that. Too rare. About as rare as PA. But I kept pushing so they started chasing a Lupus diagnosis. The ANA was negative and I was pronounced well, except for the psych issues <sigh>. > > After graduation (1992), I went to work in a community hospital med/surg ICU. At the same time, we moved and began building the `dream house' we could now afford. My four children were struggling to assimilate into a new environment and school. My oldest daughter was living with us with her baby while her husband served in Desert Storm. All four burners were full up and it wasn't long before I began floundering. One night I went to bed. It felt like me HR was about 200 and I could feel the PVCs. Each one made a pronounce thud in my chest followed by a momentary brain haze. It got so intense I finally asked my husband to take me to the ER. My potassium was 2.7. Their treatment of cure was 20mEq of effervescent potassium po and serial labs. I was released when my K+ hit 3.3. I was pronounced well and they sent me on my way. > > I scheduled an appointment with my doctor who was still not connecting the dots. He did add 20mEq of K+ daily to my meds. Things stayed pretty much the same. On anti-depressants, then off, uncontrolled HTN, micro hematuria, mild proteinuria, panic, anxiety off and on, same stuff that everyone now considered my normal. > > We built the house, kids were leaving one-by-one and the marriage had run its course. Divorce was inevitable. During this period, I developed `severe' right flank pain. It felt like if I could stick my finger inside my body up to my hand at the level of my inferior rib, I could touch where the pain was located. Now I get it. My doctor gave me some Vicodin which helped but I was miserable, couldn't find a comfortable position and it went on for 2 months. At that time he ordered a CT of my chest. God only knows why. The right adrenal adenoma (or nodule as it was described) was uncovered. Still not connecting the dots, him or me. > > That year I divorced and relocated to Houston. I was happier and felt healthier. I was even able to wean down my anti-hypertensives. This is when the issues with my back began and the introduction of daily NSAIDs. It is now a concern for me because I know there is an issue with combining NSAIDs and Spiro. Your thoughts? > > More life changes. I moved back to Chicago October 2004 and decided to give my failed marriage a second chance. It was less stressful than it had been, but still acceptable. Soon, I started having a lot of PVCs again. I was at work one night and decided to run a strip to see if these were PACs of PVCs. They were PVCs (bigeminy, trigeminy, and random). I had a nurse friend draw some blood and we sent it to lab. My potassium was 2.8. I called the pharmacy and they sent me 100 mEq of K+. It suppressed the PVCs for a few days but they returned. Again, I ran a strip, drew blood, K+ was 3.0. Sent for a supplement and went to the clinic. The doctor I had always seen left the Clinic, so I no longer had a doctor. An Immediate Care physician saw me. He ordered a 24-hr Holter and labs. The PVCs were ridiculously high. I know. I could feel every one. But nothing was done. No follow-up, consultations, referrals, or treatment. > > Things were deteriorating rapidly with the current living situation, so I moved out. I began having severe lower leg and feet cramps in 2008. I also was having frequent lower leg fasciculations, particularly when I'd lay down. I started taking B12 for the cramping which helped quite a bit. In January 2009 I moved to polis, MD to take a job at s Hopkins. A death in the family brought me home again in October 2009. I retired and it's been downhill ever since. > > Being uninsured until July 2012 (Medicare), I was seeing a NP at a local doc-in-a-box to get my prescriptions. I started having days filled with PVCs and depression. I was started back on Doxepin. Labs showed my potassium to be in the 3.0 to 3.2 range, a level that makes me symptomatic. Knowing the cause, I finally just started treating it myself, usually 80-120mEq over a day and a half and I would be okay for a couple of weeks. It was during this time that it registered how often I was urinating. It was so much that I finally bought a meter to check my BS. It was and is normal as is my A1C. > > I needed a higher level of care so I started seeing the PA at the doc-in-a-box thinking she would be consulting with the in-house doctor regarding my care. After the initial appointment, I was told they would no longer prescribe the Doxepin. The doctor thought I was taking it for sleep or selling it, not sure which. I also needed medication refills. The potassium called in was ½ my normal dose. I freaked because I was almost out and having PVCs again. So I gathered my history `evidence' and took it to the PA. She refused to prescribe the correct amount after I told her I was self-medicating and why with the proof in hand. After an embarrassing tete tete occurring in front of staff and a waiting room full of patients, I stormed out. I asked a friend pull a few strings (doctors won't see you if you're a self-pay I've discovered) and I got in to see a family practice doc in September 2011. > > Rather than have a staff member record my history incorrectly, I put it in H & P format and handed it to the doctor. While preparing the document, I decided to do some research on the causes of chronic low potassium other than the obvious (thiazide diuretic, albuterol inhaler, and recent rounds of prednisone for pneumonia). Imagine my surprise when Conn's popped up and I finally connected the dots. I am THE POSTER CHILD for Stage IV Conn's. > > When I had my appointment with the family practice doc, I said, " The bilateral adrenal adenomas are probably functional and it is highly likely that I have Conn's Syndrome " . I told him about the low potassium, my symptoms, and how I had been treating it. Much to my surprise and without labs to back up my claim, he prescribed K+ supplements equal to my bi-tri-weekly fix. However, no PA blood or urine labs were ordered and his primary concern was the right renal artery stenosis. The way I viewed that: if my aorta showed calcification in 2000, it is highly likely that the renal artery is also calcified. I thought that was probable because I have been mildly hypercalcemic for years. That I attributed to higher blood calcium levels secondary to CCB therapy. Now I am not so sure. > > I do have a question: In your Evolution article you state that one of the symptoms of the 34-year-old female was a positive Chevostek and Trousseau. Aren't those tests reflective of low blood calcium? Also, my lab abnormalities are often part of the earth metal/alkaline earth metal periodic family. Is there a correlation other than the valence numbers? > > Also, a few days a month about an hour after I take my meds, I start feeling light-headed and strange. I know now that the feeling is related to bradycardia and hypotension (HR 50's, BP 80's/30-40's). As the half-life decreases the circulating levels, my HR and BP began looking like my baseline (HR 70's, BP 140-150/80-90). When I feel that way, my radial pulse is almost not palpable. Laying down, of course, helps. So, now I am thinking that, on those days, my aldosterone is suppressed. Am I right? > > Another thing: Around 2003-4 or so, we started using Nesiritide (atrial natriuretic – ANH stimulator) instead of Dobutrex and Primacor for our CHFers. In the Evolution article, you say that increased vascular pressures promotes natriuresis. So, it follows that these patients have decompensated and no longer respond to the body's compensatory mechanism, correct? Also, does this have something to do with the push for ACE inhibitors as the lead medication in treating HTN? > > One more question: I am post-menopausal but did have night sweats before menopause that I attributed to hormone levels. I still have night sweats but these are different. I wake up about every two hours. At first I feel almost afraid, my heart starts racing, then I feel completely strange, then I get really hot. The onset of another symptom ends the prior symptom. I've timed it from the fear feeling to the end. It lasts about 4-5 minutes. Then everything returns to normal. This happens most nights sometimes every two hours all night It even happens when I nap. It is what wakes me up. I researched the symptoms and was thinking there was a correlation to LH and FSH based on the q 2 hour cycle. I also considered a release of cortisol. Now I wonder if it is part and parcel of the PA. Any thoughts? Is aldosterone released in intervals? If so, what's the time frame? > > Finally, of the Stage IV symptoms, these are the ones I've experienced: profound hypokalemia, polyuria, drug resistant HTN, hand/feet/leg cramps, profound weakness, periodic paralysis (onset when I stand but then it subsides in a couple of minutes), arrhythmias, mild proteinuria, and alkaline urine. > > There is so much more I am probably leaving out, but I am sure you will ask the questions that will free that information. So, thank you for your time and consideration. I'm looking forward to the journey. > > Barbara Tatro > > Medical History > > 1. Hypertension – DX 1989 - age 42 – Severe and resistant since DX > 2. Right Renal Artery Stenosis (70%) – 2009 > 3. Atrophic right kidney > 4. Adrenal adenoma – Left 2.2 x 2.5; Right 2.1 x 1.2 > Right diagnosed 2-2000 (1.5); Left diagnosed 6-2009 and increased size of right adenoma (described as adrenal nodules) > 5. Hypokalemia (profound – 1st incidence 1991, documented 2008-2011) > 6. Mild hypercalcemia > 7. Hypomagnesemia > 8. Micro hematuria (small) > 9. Mild proteinuria > 10. Aortic calcification > 11. Heat Intolerance > 12. Back – T11-12 Central disc extrusion, mild central canal stenosis; L1-2 bulging disc with compression of thecal sac; L2-3 bulging disc compressing thecal sac; L3-4 bulging disc, retroliathesis, central canal stenosis biforaminal stenosis; L4-5 unroofed disc, spondyloliatheses, severe central canal and biforaminal stenosis; L5-S1 extruded disc, left and right foraminal stenosis > 13. Left hip – joint space narrowing and arthritic changes, subchondral sclerosis (rheumatoid v. osteoarthritis) > 14. Left lateral leg neuropathy with atrophy > 15. Falling > 16. Pneumonia – February, May, September 2011 > 17. Bilateral otitis media – February, May, September 2011 > 18. COPD > 19. HPV > 20. GI bleed – Diffuse gastritis – 2002 secondary to NSAID therapy > 21. Fuch's Corneal Dystrophy (left eye severe, right eye mild to moderate) > 22. Basal cell carcinoma left cheek > 23. Adenomyosis – D & C x 3 1970's > 24. Fractures – right tibia, left thumb, spiral fracture right 4th toe > 25. Seasonal allergies > 26. Chronic pain > 27. Depression, anxiety and panic attacks, `nervous breakdown' x3 – first at age 19 – about every 10 years thereafter – last one 1985 > 28. Severe childhood abuse and molestation > 29. Smoker 1ppd x 40 years > > > > > Surgeries > 1. Exploratory lap, choleycystectomy - 1977 > 2. Hysteroscopy – 1995 > 3. Removal basal cell carcinoma left cheek – 2000 > > Family History > 1. Father (deceased) – CHF, multiple MI, multiple CVA, Resistant HTN, Fuch's Corneal Dystrophy, depression, HOH > 2. Mother (deceased) – HTN, cervical cancer, metastatic cancer > 3. Sister (68) – Fuch's corneal dystrophy, depression > 4. Brother (66) – Bladder cancer, thyroid cancer, HTN, Type II Diabetes, depression > 5. Brother (60) – HTN, Depression, dysrhythmia > 6. Brother (46) - Dysrhythmia, depression > > Allergies > 1. Serotonin – Seizure, anaphylaxis, Serotonin Syndrome (ER x3) > 2. Levaquin – Levaquin Syndrome > 3. Wellbutrin – Cardiac dysrhythmia > > > > Prevention > 1. Flu vaccine 11/2012 > 2. Pneumonia vaccine 11/2010 > > Medications December - 2011 > > 1. Lisinopril-Hctz 20/12.5 mg BID > 2. Verapamil 120mg BID > 3. Labetalol 200mg BID > 4. Pravastatin 20mg Q night > 5. Doxepin 75mg QD > 6. ASA 81mg BID > 7. Potassium 20 mEq BID > 8. Doxepin 75 mg QD > 9. Ibuprofen 800mg BID > 10. Zyrtec 10 mg QD > 11. Glucosam/Chon 1500/1200mg QD > 12. Vit B12 1000mcg QD > 13. Vit C 500mg QD > 14. Magnesium 250mg BID > 15. Multi-Vit 1 tab QD > 16. Fish Oil 1000 mg BID > 17. Ventolin Inhale 1-2 puffs PRN > 18. Naproxen 440mg PRN > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 12, 2012 Report Share Posted January 12, 2012 >I am now doing Weight Watchers and have altered my diet to include mostly fresh or steamed >veggies, fresh fruit, flat bread, light cream cheese, canned or smoked fish, water, etc. My salt >intake now is probably consistent with DASH.No, on this diet your salt intake definitely not consistent with DASH. Read labels on flat bread, cream cheese, canned and smoked fish! The only cheese that we really can eat is swiss/ baby swiss, NOTHING canned or smoked! Natalia Kamneva 67 Russian F with 2 cm left adrenal adenoma, still not diagnosed with PA; diabetic; on 100 mg eplerenone, 80 mg Micardis, 2000 mg metformin, 60 mg Dexilant and 2 mg Lorazepam; Dashing; still have some occasional problems with BP, K and Na; on private consultation with Dr Grim. From: Barb Tatro <rainbowdayz@...> hyperaldosteronism Sent: Thursday, January 12, 2012 2:00 AM Subject: Re: History/Story Hi, Thanks for the speedy reply. Stenosis was Dx'd June 2009. All that was done was a US of the renal arteries (DX % in terms of velocity). Within a month, I was moving. No follow-up because I retired and was uninsured. Medicare begins July 2012. The family practice doctor I am now seeing wanted this assessed by vascular. I can't afford that until Medicare kicks in. I will see vascular then. No one listened for a bruit, even my aorta which has been calcified for years. Took BCPs for about 2 months in my early 30's. I diagnosed the PA. No one else has ever even suggested it, therefore, no aldo numbers. Salt intake: Was probably average. I am now doing Weight Watchers and have altered my diet to include mostly fresh or steamed veggies, fresh fruit, flat bread, light cream cheese, canned or smoked fish, water, etc. My salt intake now is probably consistent with DASH. I looked it over and it is pretty close to the diet I've constructed for myself and that I find remarkably easy to follow. No one has ever mentioned DASHing. Why would they. Everybody is in bed with everyone else. If you fix what ails you with diet, how will the doctors and big drug companies get rich? Barbara Re: History/Story What was done if anything about the renal artery? How was the 70% Dxed? Did anyone hear a bruit over that artery? Have you ever taken BCPs? Don't see any renin aldo numbers? How much salt do you eat? Anyone ever mention DASHing? On Jan 11, 2012, at 11:18 PM, amazingkeltic wrote: Dear Dr. Grim,I am a 64-year-old female. I am a retired surgical heart ICU CCRN. I returned to college at age 39, and obtained a BSN. I also student taught A & P and Micro labs for 12 years post-graduation at Indiana University NW. I relocated to Houston, TX in 2001. During my nursing tenure, I worked in community hospitals and for several prestigious institutions including Methodist Hospital, Texas Medical Center, Houston, for and with DeBakey. I also worked for Hazim Safi's AAA unit at Memorial Hermann while in Houston. I have presented at several critical care consortiums and served as clinical educator at many of the facilities where I worked. So… looking back on this medical journey confounds me. I, of all people, should have done the research and found the answer. I attribute part of this phenomenon to the lack of computer skills. I bought my first computer in 2000. I wasn't what I would consider `computer literate' for a few more years. By this time, I was easily 15 years into my PA odyssey and convinced by professionals I trusted that my right adenoma was just an `incidental' finding and quite common. I pride myself in my knowledge base and assessment skills, but I very clearly dropped the ball when it came to me.I do not hold contempt for the doctors who led me astray. If I couldn't see the writing on the wall, why should they. I will say this, in 20+ years of critical care nursing I never once cared for a patient with PA as a primary or secondary diagnosis and I rarely cared for a patient whose home medications included Spironolactone. Fewer still were prescribed Spiro during their hospitalization. The beginning of the end: I was diagnosed with HTN during a routine screening to begin my nursing clinicals (age 42). The person who diagnosed it was an itty bitty nun who was about 104. Poor thing could barely inflate the cuff. Her first reading: 170/104. I assumed the extended inflation time had something to do with it and asked that she repeat it. She did. No change. The doctor that followed confirmed the DX. Begin the litany of BP meds dispensed so conservatively, I am surprised I didn't stroke while waiting. Every change that was made required a waiting period and another visit. Finally, a few years in, I showed some progress. BPs were generally 140-150's/80-90's and that was on a good day. The doc took the standard approach: started with a diuretic then added a CCB, ACE, and finally a b-blocker. See attachment for current medications. The b-blocker was Labetalol. When this was added (due to the alpha blocking), I completely stopped have the adrenalin rushes I had for years – so the offender was nor-epi and not epi? But this created an anti-depressant dilemma: block it with one med, then hold it in the synapse with another… hmmmm… the old come here, go away therapy. Any suggestions because I am on both currently?From age 19 until my diagnosis and treatment for clinical depression in 1985, I had repeated episodes of depression, anxiety attacks, panic attacks, even agoraphobia. When I was finally diagnosed, I was put on Doxepin and have taken it intermittently since that time. My history includes severe child abuse and molestation. So what do I do after I escaped? I, in essence, married my father and the abuse and stress continued. I just kept throwing more logs on the fire. I therefore attributed much of what I was experiencing to my history. I assumed my resistant pressures were anxiety-driven. During this time, I could feel the release of adrenalin. It hit my chest like 360joules. Then the panic and anxiety would ensue. After reading The Evolution, I see that psycho-social stress can produce adenomas. Huge ah-ha moment for this critical care RN. During this time, I suggested a possible pheochromocytoma diagnosis. With the uncontrollable HTN and added microhematuria and mild proteinuria I was beginning to have real concerns. Docs weren't buying that. Too rare. About as rare as PA. But I kept pushing so they started chasing a Lupus diagnosis. The ANA was negative and I was pronounced well, except for the psych issues <sigh>.After graduation (1992), I went to work in a community hospital med/surg ICU. At the same time, we moved and began building the `dream house' we could now afford. My four children were struggling to assimilate into a new environment and school. My oldest daughter was living with us with her baby while her husband served in Desert Storm. All four burners were full up and it wasn't long before I began floundering. One night I went to bed. It felt like me HR was about 200 and I could feel the PVCs. Each one made a pronounce thud in my chest followed by a momentary brain haze. It got so intense I finally asked my husband to take me to the ER. My potassium was 2.7. Their treatment of cure was 20mEq of effervescent potassium po and serial labs. I was released when my K+ hit 3.3. I was pronounced well and they sent me on my way.I scheduled an appointment with my doctor who was still not connecting the dots. He did add 20mEq of K+ daily to my meds. Things stayed pretty much the same. On anti-depressants, then off, uncontrolled HTN, micro hematuria, mild proteinuria, panic, anxiety off and on, same stuff that everyone now considered my normal.We built the house, kids were leaving one-by-one and the marriage had run its course. Divorce was inevitable. During this period, I developed `severe' right flank pain. It felt like if I could stick my finger inside my body up to my hand at the level of my inferior rib, I could touch where the pain was located. Now I get it. My doctor gave me some Vicodin which helped but I was miserable, couldn't find a comfortable position and it went on for 2 months. At that time he ordered a CT of my chest. God only knows why. The right adrenal adenoma (or nodule as it was described) was uncovered. Still not connecting the dots, him or me. That year I divorced and relocated to Houston. I was happier and felt healthier. I was even able to wean down my anti-hypertensives. This is when the issues with my back began and the introduction of daily NSAIDs. It is now a concern for me because I know there is an issue with combining NSAIDs and Spiro. Your thoughts?More life changes. I moved back to Chicago October 2004 and decided to give my failed marriage a second chance. It was less stressful than it had been, but still acceptable. Soon, I started having a lot of PVCs again. I was at work one night and decided to run a strip to see if these were PACs of PVCs. They were PVCs (bigeminy, trigeminy, and random). I had a nurse friend draw some blood and we sent it to lab. My potassium was 2.8. I called the pharmacy and they sent me 100 mEq of K+. It suppressed the PVCs for a few days but they returned. Again, I ran a strip, drew blood, K+ was 3.0. Sent for a supplement and went to the clinic. The doctor I had always seen left the Clinic, so I no longer had a doctor. An Immediate Care physician saw me. He ordered a 24-hr Holter and labs. The PVCs were ridiculously high. I know. I could feel every one. But nothing was done. No follow-up, consultations, referrals, or treatment.Things were deteriorating rapidly with the current living situation, so I moved out. I began having severe lower leg and feet cramps in 2008. I also was having frequent lower leg fasciculations, particularly when I'd lay down. I started taking B12 for the cramping which helped quite a bit. In January 2009 I moved to polis, MD to take a job at s Hopkins. A death in the family brought me home again in October 2009. I retired and it's been downhill ever since. Being uninsured until July 2012 (Medicare), I was seeing a NP at a local doc-in-a-box to get my prescriptions. I started having days filled with PVCs and depression. I was started back on Doxepin. Labs showed my potassium to be in the 3.0 to 3.2 range, a level that makes me symptomatic. Knowing the cause, I finally just started treating it myself, usually 80-120mEq over a day and a half and I would be okay for a couple of weeks. It was during this time that it registered how often I was urinating. It was so much that I finally bought a meter to check my BS. It was and is normal as is my A1C.I needed a higher level of care so I started seeing the PA at the doc-in-a-box thinking she would be consulting with the in-house doctor regarding my care. After the initial appointment, I was told they would no longer prescribe the Doxepin. The doctor thought I was taking it for sleep or selling it, not sure which. I also needed medication refills. The potassium called in was ½ my normal dose. I freaked because I was almost out and having PVCs again. So I gathered my history `evidence' and took it to the PA. She refused to prescribe the correct amount after I told her I was self-medicating and why with the proof in hand. After an embarrassing tete tete occurring in front of staff and a waiting room full of patients, I stormed out. I asked a friend pull a few strings (doctors won't see you if you're a self-pay I've discovered) and I got in to see a family practice doc in September 2011. Rather than have a staff member record my history incorrectly, I put it in H & P format and handed it to the doctor. While preparing the document, I decided to do some research on the causes of chronic low potassium other than the obvious (thiazide diuretic, albuterol inhaler, and recent rounds of prednisone for pneumonia). Imagine my surprise when Conn's popped up and I finally connected the dots. I am THE POSTER CHILD for Stage IV Conn's. When I had my appointment with the family practice doc, I said, "The bilateral adrenal adenomas are probably functional and it is highly likely that I have Conn's Syndrome". I told him about the low potassium, my symptoms, and how I had been treating it. Much to my surprise and without labs to back up my claim, he prescribed K+ supplements equal to my bi-tri-weekly fix. However, no PA blood or urine labs were ordered and his primary concern was the right renal artery stenosis. The way I viewed that: if my aorta showed calcification in 2000, it is highly likely that the renal artery is also calcified. I thought that was probable because I have been mildly hypercalcemic for years. That I attributed to higher blood calcium levels secondary to CCB therapy. Now I am not so sure.I do have a question: In your Evolution article you state that one of the symptoms of the 34-year-old female was a positive Chevostek and Trousseau. Aren't those tests reflective of low blood calcium? Also, my lab abnormalities are often part of the earth metal/alkaline earth metal periodic family. Is there a correlation other than the valence numbers?Also, a few days a month about an hour after I take my meds, I start feeling light-headed and strange. I know now that the feeling is related to bradycardia and hypotension (HR 50's, BP 80's/30-40's). As the half-life decreases the circulating levels, my HR and BP began looking like my baseline (HR 70's, BP 140-150/80-90). When I feel that way, my radial pulse is almost not palpable. Laying down, of course, helps. So, now I am thinking that, on those days, my aldosterone is suppressed. Am I right?Another thing: Around 2003-4 or so, we started using Nesiritide (atrial natriuretic – ANH stimulator) instead of Dobutrex and Primacor for our CHFers. In the Evolution article, you say that increased vascular pressures promotes natriuresis. So, it follows that these patients have decompensated and no longer respond to the body's compensatory mechanism, correct? Also, does this have something to do with the push for ACE inhibitors as the lead medication in treating HTN?One more question: I am post-menopausal but did have night sweats before menopause that I attributed to hormone levels. I still have night sweats but these are different. I wake up about every two hours. At first I feel almost afraid, my heart starts racing, then I feel completely strange, then I get really hot. The onset of another symptom ends the prior symptom. I've timed it from the fear feeling to the end. It lasts about 4-5 minutes. Then everything returns to normal. This happens most nights sometimes every two hours all night It even happens when I nap. It is what wakes me up. I researched the symptoms and was thinking there was a correlation to LH and FSH based on the q 2 hour cycle. I also considered a release of cortisol. Now I wonder if it is part and parcel of the PA. Any thoughts? Is aldosterone released in intervals? If so, what's the time frame?Finally, of the Stage IV symptoms, these are the ones I've experienced: profound hypokalemia, polyuria, drug resistant HTN, hand/feet/leg cramps, profound weakness, periodic paralysis (onset when I stand but then it subsides in a couple of minutes), arrhythmias, mild proteinuria, and alkaline urine.There is so much more I am probably leaving out, but I am sure you will ask the questions that will free that information. So, thank you for your time and consideration. I'm looking forward to the journey.Barbara TatroMedical History1. Hypertension – DX 1989 - age 42 – Severe and resistant since DX2. Right Renal Artery Stenosis (70%) – 20093. Atrophic right kidney4. Adrenal adenoma – Left 2.2 x 2.5; Right 2.1 x 1.2 Right diagnosed 2-2000 (1.5); Left diagnosed 6-2009 and increased size of right adenoma (described as adrenal nodules)5. Hypokalemia (profound – 1st incidence 1991, documented 2008-2011)6. Mild hypercalcemia7. Hypomagnesemia8. Micro hematuria (small)9. Mild proteinuria10. Aortic calcification11. Heat Intolerance12. Back – T11-12 Central disc extrusion, mild central canal stenosis; L1-2 bulging disc with compression of thecal sac; L2-3 bulging disc compressing thecal sac; L3-4 bulging disc, retroliathesis, central canal stenosis biforaminal stenosis; L4-5 unroofed disc, spondyloliatheses, severe central canal and biforaminal stenosis; L5-S1 extruded disc, left and right foraminal stenosis13. Left hip – joint space narrowing and arthritic changes, subchondral sclerosis (rheumatoid v. osteoarthritis)14. Left lateral leg neuropathy with atrophy15. Falling16. Pneumonia – February, May, September 201117. Bilateral otitis media – February, May, September 201118. COPD19. HPV20. GI bleed – Diffuse gastritis – 2002 secondary to NSAID therapy21. Fuch's Corneal Dystrophy (left eye severe, right eye mild to moderate)22. Basal cell carcinoma left cheek 23. Adenomyosis – D & C x 3 1970's24. Fractures – right tibia, left thumb, spiral fracture right 4th toe25. Seasonal allergies26. Chronic pain27. Depression, anxiety and panic attacks, `nervous breakdown' x3 – first at age 19 – about every 10 years thereafter – last one 198528. Severe childhood abuse and molestation29. Smoker 1ppd x 40 yearsSurgeries1. Exploratory lap, choleycystectomy - 19772. Hysteroscopy – 19953. Removal basal cell carcinoma left cheek – 2000Family History1. Father (deceased) – CHF, multiple MI, multiple CVA, Resistant HTN, Fuch's Corneal Dystrophy, depression, HOH2. Mother (deceased) – HTN, cervical cancer, metastatic cancer 3. Sister (68) – Fuch's corneal dystrophy, depression4. Brother (66) – Bladder cancer, thyroid cancer, HTN, Type II Diabetes, depression5. Brother (60) – HTN, Depression, dysrhythmia6. Brother (46) - Dysrhythmia, depressionAllergies1. Serotonin – Seizure, anaphylaxis, Serotonin Syndrome (ER x3)2. Levaquin – Levaquin Syndrome3. Wellbutrin – Cardiac dysrhythmiaPrevention1. Flu vaccine 11/20122. Pneumonia vaccine 11/2010Medications December - 20111. Lisinopril-Hctz 20/12.5 mg BID2. Verapamil 120mg BID3. Labetalol 200mg BID 4. Pravastatin 20mg Q night5. Doxepin 75mg QD6. ASA 81mg BID7. Potassium 20 mEq BID8. Doxepin 75 mg QD9. Ibuprofen 800mg BID10. Zyrtec 10 mg QD11. Glucosam/Chon 1500/1200mg QD12. Vit B12 1000mcg QD13. Vit C 500mg QD14. Magnesium 250mg BID15. Multi-Vit 1 tab QD16. Fish Oil 1000 mg BID17. Ventolin Inhale 1-2 puffs PRN18. Naproxen 440mg PRN Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 12, 2012 Report Share Posted January 12, 2012  Should clarify. The cheese is Laughing Cow light Swiss. The smoked salmon is 0.5 oz once a day on flat (180mg/2) with the light Swiss. The tuna (180mg) every third day or so. I use no table salt, do not drink anything but water and 1 cup of coffee/day. I season with herbs and lemon only. The bulk of my diet is mostly raw fruits and veggies. No red meat, potatoes, or bread. I will take a closer look at DASH now that I have imbedded. I will make alterations accordingly. Thanks for your insight and input. Barb Re: History/Story What was done if anything about the renal artery? How was the 70% Dxed? Did anyone hear a bruit over that artery? Have you ever taken BCPs? Don't see any renin aldo numbers? How much salt do you eat? Anyone ever mention DASHing? On Jan 11, 2012, at 11:18 PM, amazingkeltic wrote: Dear Dr. Grim,I am a 64-year-old female. I am a retired surgical heart ICU CCRN. I returned to college at age 39, and obtained a BSN. I also student taught A & P and Micro labs for 12 years post-graduation at Indiana University NW. I relocated to Houston, TX in 2001. During my nursing tenure, I worked in community hospitals and for several prestigious institutions including Methodist Hospital, Texas Medical Center, Houston, for and with DeBakey. I also worked for Hazim Safi's AAA unit at Memorial Hermann while in Houston. I have presented at several critical care consortiums and served as clinical educator at many of the facilities where I worked. So… looking back on this medical journey confounds me. I, of all people, should have done the research and found the answer. I attribute part of this phenomenon to the lack of computer skills. I bought my first computer in 2000. I wasn't what I would consider `computer literate' for a few more years. By this time, I was easily 15 years into my PA odyssey and convinced by professionals I trusted that my right adenoma was just an `incidental' finding and quite common. I pride myself in my knowledge base and assessment skills, but I very clearly dropped the ball when it came to me.I do not hold contempt for the doctors who led me astray. If I couldn't see the writing on the wall, why should they. I will say this, in 20+ years of critical care nursing I never once cared for a patient with PA as a primary or secondary diagnosis and I rarely cared for a patient whose home medications included Spironolactone. Fewer still were prescribed Spiro during their hospitalization. The beginning of the end: I was diagnosed with HTN during a routine screening to begin my nursing clinicals (age 42). The person who diagnosed it was an itty bitty nun who was about 104. Poor thing could barely inflate the cuff. Her first reading: 170/104. I assumed the extended inflation time had something to do with it and asked that she repeat it. She did. No change. The doctor that followed confirmed the DX. Begin the litany of BP meds dispensed so conservatively, I am surprised I didn't stroke while waiting. Every change that was made required a waiting period and another visit. Finally, a few years in, I showed some progress. BPs were generally 140-150's/80-90's and that was on a good day. The doc took the standard approach: started with a diuretic then added a CCB, ACE, and finally a b-blocker. See attachment for current medications. The b-blocker was Labetalol. When this was added (due to the alpha blocking), I completely stopped have the adrenalin rushes I had for years – so the offender was nor-epi and not epi? But this created an anti-depressant dilemma: block it with one med, then hold it in the synapse with another… hmmmm… the old come here, go away therapy. Any suggestions because I am on both currently?From age 19 until my diagnosis and treatment for clinical depression in 1985, I had repeated episodes of depression, anxiety attacks, panic attacks, even agoraphobia. When I was finally diagnosed, I was put on Doxepin and have taken it intermittently since that time. My history includes severe child abuse and molestation. So what do I do after I escaped? I, in essence, married my father and the abuse and stress continued. I just kept throwing more logs on the fire. I therefore attributed much of what I was experiencing to my history. I assumed my resistant pressures were anxiety-driven. During this time, I could feel the release of adrenalin. It hit my chest like 360joules. Then the panic and anxiety would ensue. After reading The Evolution, I see that psycho-social stress can produce adenomas. Huge ah-ha moment for this critical care RN. During this time, I suggested a possible pheochromocytoma diagnosis. With the uncontrollable HTN and added microhematuria and mild proteinuria I was beginning to have real concerns. Docs weren't buying that. Too rare. About as rare as PA. But I kept pushing so they started chasing a Lupus diagnosis. The ANA was negative and I was pronounced well, except for the psych issues <sigh>.After graduation (1992), I went to work in a community hospital med/surg ICU. At the same time, we moved and began building the `dream house' we could now afford. My four children were struggling to assimilate into a new environment and school. My oldest daughter was living with us with her baby while her husband served in Desert Storm. All four burners were full up and it wasn't long before I began floundering. One night I went to bed. It felt like me HR was about 200 and I could feel the PVCs. Each one made a pronounce thud in my chest followed by a momentary brain haze. It got so intense I finally asked my husband to take me to the ER. My potassium was 2.7. Their treatment of cure was 20mEq of effervescent potassium po and serial labs. I was released when my K+ hit 3.3. I was pronounced well and they sent me on my way.I scheduled an appointment with my doctor who was still not connecting the dots. He did add 20mEq of K+ daily to my meds. Things stayed pretty much the same. On anti-depressants, then off, uncontrolled HTN, micro hematuria, mild proteinuria, panic, anxiety off and on, same stuff that everyone now considered my normal.We built the house, kids were leaving one-by-one and the marriage had run its course. Divorce was inevitable. During this period, I developed `severe' right flank pain. It felt like if I could stick my finger inside my body up to my hand at the level of my inferior rib, I could touch where the pain was located. Now I get it. My doctor gave me some Vicodin which helped but I was miserable, couldn't find a comfortable position and it went on for 2 months. At that time he ordered a CT of my chest. God only knows why. The right adrenal adenoma (or nodule as it was described) was uncovered. Still not connecting the dots, him or me. That year I divorced and relocated to Houston. I was happier and felt healthier. I was even able to wean down my anti-hypertensives. This is when the issues with my back began and the introduction of daily NSAIDs. It is now a concern for me because I know there is an issue with combining NSAIDs and Spiro. Your thoughts?More life changes. I moved back to Chicago October 2004 and decided to give my failed marriage a second chance. It was less stressful than it had been, but still acceptable. Soon, I started having a lot of PVCs again. I was at work one night and decided to run a strip to see if these were PACs of PVCs. They were PVCs (bigeminy, trigeminy, and random). I had a nurse friend draw some blood and we sent it to lab. My potassium was 2.8. I called the pharmacy and they sent me 100 mEq of K+. It suppressed the PVCs for a few days but they returned. Again, I ran a strip, drew blood, K+ was 3.0. Sent for a supplement and went to the clinic. The doctor I had always seen left the Clinic, so I no longer had a doctor. An Immediate Care physician saw me. He ordered a 24-hr Holter and labs. The PVCs were ridiculously high. I know. I could feel every one. But nothing was done. No follow-up, consultations, referrals, or treatment.Things were deteriorating rapidly with the current living situation, so I moved out. I began having severe lower leg and feet cramps in 2008. I also was having frequent lower leg fasciculations, particularly when I'd lay down. I started taking B12 for the cramping which helped quite a bit. In January 2009 I moved to polis, MD to take a job at s Hopkins. A death in the family brought me home again in October 2009. I retired and it's been downhill ever since. Being uninsured until July 2012 (Medicare), I was seeing a NP at a local doc-in-a-box to get my prescriptions. I started having days filled with PVCs and depression. I was started back on Doxepin. Labs showed my potassium to be in the 3.0 to 3.2 range, a level that makes me symptomatic. Knowing the cause, I finally just started treating it myself, usually 80-120mEq over a day and a half and I would be okay for a couple of weeks. It was during this time that it registered how often I was urinating. It was so much that I finally bought a meter to check my BS. It was and is normal as is my A1C.I needed a higher level of care so I started seeing the PA at the doc-in-a-box thinking she would be consulting with the in-house doctor regarding my care. After the initial appointment, I was told they would no longer prescribe the Doxepin. The doctor thought I was taking it for sleep or selling it, not sure which. I also needed medication refills. The potassium called in was ½ my normal dose. I freaked because I was almost out and having PVCs again. So I gathered my history `evidence' and took it to the PA. She refused to prescribe the correct amount after I told her I was self-medicating and why with the proof in hand. After an embarrassing tete tete occurring in front of staff and a waiting room full of patients, I stormed out. I asked a friend pull a few strings (doctors won't see you if you're a self-pay I've discovered) and I got in to see a family practice doc in September 2011. Rather than have a staff member record my history incorrectly, I put it in H & P format and handed it to the doctor. While preparing the document, I decided to do some research on the causes of chronic low potassium other than the obvious (thiazide diuretic, albuterol inhaler, and recent rounds of prednisone for pneumonia). Imagine my surprise when Conn's popped up and I finally connected the dots. I am THE POSTER CHILD for Stage IV Conn's. When I had my appointment with the family practice doc, I said, "The bilateral adrenal adenomas are probably functional and it is highly likely that I have Conn's Syndrome". I told him about the low potassium, my symptoms, and how I had been treating it. Much to my surprise and without labs to back up my claim, he prescribed K+ supplements equal to my bi-tri-weekly fix. However, no PA blood or urine labs were ordered and his primary concern was the right renal artery stenosis. The way I viewed that: if my aorta showed calcification in 2000, it is highly likely that the renal artery is also calcified. I thought that was probable because I have been mildly hypercalcemic for years. That I attributed to higher blood calcium levels secondary to CCB therapy. Now I am not so sure.I do have a question: In your Evolution article you state that one of the symptoms of the 34-year-old female was a positive Chevostek and Trousseau. Aren't those tests reflective of low blood calcium? Also, my lab abnormalities are often part of the earth metal/alkaline earth metal periodic family. Is there a correlation other than the valence numbers?Also, a few days a month about an hour after I take my meds, I start feeling light-headed and strange. I know now that the feeling is related to bradycardia and hypotension (HR 50's, BP 80's/30-40's). As the half-life decreases the circulating levels, my HR and BP began looking like my baseline (HR 70's, BP 140-150/80-90). When I feel that way, my radial pulse is almost not palpable. Laying down, of course, helps. So, now I am thinking that, on those days, my aldosterone is suppressed. Am I right?Another thing: Around 2003-4 or so, we started using Nesiritide (atrial natriuretic – ANH stimulator) instead of Dobutrex and Primacor for our CHFers. In the Evolution article, you say that increased vascular pressures promotes natriuresis. So, it follows that these patients have decompensated and no longer respond to the body's compensatory mechanism, correct? Also, does this have something to do with the push for ACE inhibitors as the lead medication in treating HTN?One more question: I am post-menopausal but did have night sweats before menopause that I attributed to hormone levels. I still have night sweats but these are different. I wake up about every two hours. At first I feel almost afraid, my heart starts racing, then I feel completely strange, then I get really hot. The onset of another symptom ends the prior symptom. I've timed it from the fear feeling to the end. It lasts about 4-5 minutes. Then everything returns to normal. This happens most nights sometimes every two hours all night It even happens when I nap. It is what wakes me up. I researched the symptoms and was thinking there was a correlation to LH and FSH based on the q 2 hour cycle. I also considered a release of cortisol. Now I wonder if it is part and parcel of the PA. Any thoughts? Is aldosterone released in intervals? If so, what's the time frame?Finally, of the Stage IV symptoms, these are the ones I've experienced: profound hypokalemia, polyuria, drug resistant HTN, hand/feet/leg cramps, profound weakness, periodic paralysis (onset when I stand but then it subsides in a couple of minutes), arrhythmias, mild proteinuria, and alkaline urine.There is so much more I am probably leaving out, but I am sure you will ask the questions that will free that information. So, thank you for your time and consideration. I'm looking forward to the journey.Barbara TatroMedical History1. Hypertension – DX 1989 - age 42 – Severe and resistant since DX2. Right Renal Artery Stenosis (70%) – 20093. Atrophic right kidney4. Adrenal adenoma – Left 2.2 x 2.5; Right 2.1 x 1.2 Right diagnosed 2-2000 (1.5); Left diagnosed 6-2009 and increased size of right adenoma (described as adrenal nodules)5. Hypokalemia (profound – 1st incidence 1991, documented 2008-2011)6. Mild hypercalcemia7. Hypomagnesemia8. Micro hematuria (small)9. Mild proteinuria10. Aortic calcification11. Heat Intolerance12. Back – T11-12 Central disc extrusion, mild central canal stenosis; L1-2 bulging disc with compression of thecal sac; L2-3 bulging disc compressing thecal sac; L3-4 bulging disc, retroliathesis, central canal stenosis biforaminal stenosis; L4-5 unroofed disc, spondyloliatheses, severe central canal and biforaminal stenosis; L5-S1 extruded disc, left and right foraminal stenosis13. Left hip – joint space narrowing and arthritic changes, subchondral sclerosis (rheumatoid v. osteoarthritis)14. Left lateral leg neuropathy with atrophy15. Falling16. Pneumonia – February, May, September 201117. Bilateral otitis media – February, May, September 201118. COPD19. HPV20. GI bleed – Diffuse gastritis – 2002 secondary to NSAID therapy21. Fuch's Corneal Dystrophy (left eye severe, right eye mild to moderate)22. Basal cell carcinoma left cheek 23. Adenomyosis – D & C x 3 1970's24. Fractures – right tibia, left thumb, spiral fracture right 4th toe25. Seasonal allergies26. Chronic pain27. Depression, anxiety and panic attacks, `nervous breakdown' x3 – first at age 19 – about every 10 years thereafter – last one 198528. Severe childhood abuse and molestation29. Smoker 1ppd x 40 yearsSurgeries1. Exploratory lap, choleycystectomy - 19772. Hysteroscopy – 19953. Removal basal cell carcinoma left cheek – 2000Family History1. Father (deceased) – CHF, multiple MI, multiple CVA, Resistant HTN, Fuch's Corneal Dystrophy, depression, HOH2. Mother (deceased) – HTN, cervical cancer, metastatic cancer 3. Sister (68) – Fuch's corneal dystrophy, depression4. Brother (66) – Bladder cancer, thyroid cancer, HTN, Type II Diabetes, depression5. Brother (60) – HTN, Depression, dysrhythmia6. Brother (46) - Dysrhythmia, depressionAllergies1. Serotonin – Seizure, anaphylaxis, Serotonin Syndrome (ER x3)2. Levaquin – Levaquin Syndrome3. Wellbutrin – Cardiac dysrhythmiaPrevention1. Flu vaccine 11/20122. Pneumonia vaccine 11/2010Medications December - 20111. Lisinopril-Hctz 20/12.5 mg BID2. Verapamil 120mg BID3. Labetalol 200mg BID 4. Pravastatin 20mg Q night5. Doxepin 75mg QD6. ASA 81mg BID7. Potassium 20 mEq BID8. Doxepin 75 mg QD9. Ibuprofen 800mg BID10. Zyrtec 10 mg QD11. Glucosam/Chon 1500/1200mg QD12. Vit B12 1000mcg QD13. Vit C 500mg QD14. Magnesium 250mg BID15. Multi-Vit 1 tab QD16. Fish Oil 1000 mg BID17. Ventolin Inhale 1-2 puffs PRN18. Naproxen 440mg PRN Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 13, 2012 Report Share Posted January 13, 2012 Ca in OrtaCa in aorta means u have had atherosclerosis for a long time. Starts in teen ages or before as we can see it in teens. Trust u are. I longer smoking. What have your lipids been?May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Jan 12, 2012, at 22:21, Natalia Kamneva <natalia_kamneva@...> wrote: >I am now doing Weight Watchers and have altered my diet to include mostly fresh or steamed >veggies, fresh fruit, flat bread, light cream cheese, canned or smoked fish, water, etc. My salt >intake now is probably consistent with DASH.No, on this diet your salt intake definitely not consistent with DASH. Read labels on flat bread, cream cheese, canned and smoked fish! The only cheese that we really can eat is swiss/ baby swiss, NOTHING canned or smoked! Natalia Kamneva 67 Russian F with 2 cm left adrenal adenoma, still not diagnosed with PA; diabetic; on 100 mg eplerenone, 80 mg Micardis, 2000 mg metformin, 60 mg Dexilant and 2 mg Lorazepam; Dashing; still have some occasional problems with BP, K and Na; on private consultation with Dr Grim. From: Barb Tatro <rainbowdayz@...> hyperaldosteronism Sent: Thursday, January 12, 2012 2:00 AM Subject: Re: History/Story Hi, Thanks for the speedy reply. Stenosis was Dx'd June 2009. All that was done was a US of the renal arteries (DX % in terms of velocity). Within a month, I was moving. No follow-up because I retired and was uninsured. Medicare begins July 2012. The family practice doctor I am now seeing wanted this assessed by vascular. I can't afford that until Medicare kicks in. I will see vascular then. No one listened for a bruit, even my aorta which has been calcified for years. Took BCPs for about 2 months in my early 30's. I diagnosed the PA. No one else has ever even suggested it, therefore, no aldo numbers. Salt intake: Was probably average. I am now doing Weight Watchers and have altered my diet to include mostly fresh or steamed veggies, fresh fruit, flat bread, light cream cheese, canned or smoked fish, water, etc. My salt intake now is probably consistent with DASH. I looked it over and it is pretty close to the diet I've constructed for myself and that I find remarkably easy to follow. No one has ever mentioned DASHing. Why would they. Everybody is in bed with everyone else. If you fix what ails you with diet, how will the doctors and big drug companies get rich? Barbara Re: History/Story What was done if anything about the renal artery? How was the 70% Dxed? Did anyone hear a bruit over that artery? Have you ever taken BCPs? Don't see any renin aldo numbers? How much salt do you eat? Anyone ever mention DASHing? On Jan 11, 2012, at 11:18 PM, amazingkeltic wrote: Dear Dr. Grim,I am a 64-year-old female. I am a retired surgical heart ICU CCRN. I returned to college at age 39, and obtained a BSN. I also student taught A & P and Micro labs for 12 years post-graduation at Indiana University NW. I relocated to Houston, TX in 2001. During my nursing tenure, I worked in community hospitals and for several prestigious institutions including Methodist Hospital, Texas Medical Center, Houston, for and with DeBakey. I also worked for Hazim Safi's AAA unit at Memorial Hermann while in Houston. I have presented at several critical care consortiums and served as clinical educator at many of the facilities where I worked. So… looking back on this medical journey confounds me. I, of all people, should have done the research and found the answer. I attribute part of this phenomenon to the lack of computer skills. I bought my first computer in 2000. I wasn't what I would consider `computer literate' for a few more years. By this time, I was easily 15 years into my PA odyssey and convinced by professionals I trusted that my right adenoma was just an `incidental' finding and quite common. I pride myself in my knowledge base and assessment skills, but I very clearly dropped the ball when it came to me.I do not hold contempt for the doctors who led me astray. If I couldn't see the writing on the wall, why should they. I will say this, in 20+ years of critical care nursing I never once cared for a patient with PA as a primary or secondary diagnosis and I rarely cared for a patient whose home medications included Spironolactone. Fewer still were prescribed Spiro during their hospitalization. The beginning of the end: I was diagnosed with HTN during a routine screening to begin my nursing clinicals (age 42). The person who diagnosed it was an itty bitty nun who was about 104. Poor thing could barely inflate the cuff. Her first reading: 170/104. I assumed the extended inflation time had something to do with it and asked that she repeat it. She did. No change. The doctor that followed confirmed the DX. Begin the litany of BP meds dispensed so conservatively, I am surprised I didn't stroke while waiting. Every change that was made required a waiting period and another visit. Finally, a few years in, I showed some progress. BPs were generally 140-150's/80-90's and that was on a good day. The doc took the standard approach: started with a diuretic then added a CCB, ACE, and finally a b-blocker. See attachment for current medications. The b-blocker was Labetalol. When this was added (due to the alpha blocking), I completely stopped have the adrenalin rushes I had for years – so the offender was nor-epi and not epi? But this created an anti-depressant dilemma: block it with one med, then hold it in the synapse with another… hmmmm… the old come here, go away therapy. Any suggestions because I am on both currently?From age 19 until my diagnosis and treatment for clinical depression in 1985, I had repeated episodes of depression, anxiety attacks, panic attacks, even agoraphobia. When I was finally diagnosed, I was put on Doxepin and have taken it intermittently since that time. My history includes severe child abuse and molestation. So what do I do after I escaped? I, in essence, married my father and the abuse and stress continued. I just kept throwing more logs on the fire. I therefore attributed much of what I was experiencing to my history. I assumed my resistant pressures were anxiety-driven. During this time, I could feel the release of adrenalin. It hit my chest like 360joules. Then the panic and anxiety would ensue. After reading The Evolution, I see that psycho-social stress can produce adenomas. Huge ah-ha moment for this critical care RN. During this time, I suggested a possible pheochromocytoma diagnosis. With the uncontrollable HTN and added microhematuria and mild proteinuria I was beginning to have real concerns. Docs weren't buying that. Too rare. About as rare as PA. But I kept pushing so they started chasing a Lupus diagnosis. The ANA was negative and I was pronounced well, except for the psych issues <sigh>.After graduation (1992), I went to work in a community hospital med/surg ICU. At the same time, we moved and began building the `dream house' we could now afford. My four children were struggling to assimilate into a new environment and school. My oldest daughter was living with us with her baby while her husband served in Desert Storm. All four burners were full up and it wasn't long before I began floundering. One night I went to bed. It felt like me HR was about 200 and I could feel the PVCs. Each one made a pronounce thud in my chest followed by a momentary brain haze. It got so intense I finally asked my husband to take me to the ER. My potassium was 2.7. Their treatment of cure was 20mEq of effervescent potassium po and serial labs. I was released when my K+ hit 3.3. I was pronounced well and they sent me on my way.I scheduled an appointment with my doctor who was still not connecting the dots. He did add 20mEq of K+ daily to my meds. Things stayed pretty much the same. On anti-depressants, then off, uncontrolled HTN, micro hematuria, mild proteinuria, panic, anxiety off and on, same stuff that everyone now considered my normal.We built the house, kids were leaving one-by-one and the marriage had run its course. Divorce was inevitable. During this period, I developed `severe' right flank pain. It felt like if I could stick my finger inside my body up to my hand at the level of my inferior rib, I could touch where the pain was located. Now I get it. My doctor gave me some Vicodin which helped but I was miserable, couldn't find a comfortable position and it went on for 2 months. At that time he ordered a CT of my chest. God only knows why. The right adrenal adenoma (or nodule as it was described) was uncovered. Still not connecting the dots, him or me. That year I divorced and relocated to Houston. I was happier and felt healthier. I was even able to wean down my anti-hypertensives. This is when the issues with my back began and the introduction of daily NSAIDs. It is now a concern for me because I know there is an issue with combining NSAIDs and Spiro. Your thoughts?More life changes. I moved back to Chicago October 2004 and decided to give my failed marriage a second chance. It was less stressful than it had been, but still acceptable. Soon, I started having a lot of PVCs again. I was at work one night and decided to run a strip to see if these were PACs of PVCs. They were PVCs (bigeminy, trigeminy, and random). I had a nurse friend draw some blood and we sent it to lab. My potassium was 2.8. I called the pharmacy and they sent me 100 mEq of K+. It suppressed the PVCs for a few days but they returned. Again, I ran a strip, drew blood, K+ was 3.0. Sent for a supplement and went to the clinic. The doctor I had always seen left the Clinic, so I no longer had a doctor. An Immediate Care physician saw me. He ordered a 24-hr Holter and labs. The PVCs were ridiculously high. I know. I could feel every one. But nothing was done. No follow-up, consultations, referrals, or treatment.Things were deteriorating rapidly with the current living situation, so I moved out. I began having severe lower leg and feet cramps in 2008. I also was having frequent lower leg fasciculations, particularly when I'd lay down. I started taking B12 for the cramping which helped quite a bit. In January 2009 I moved to polis, MD to take a job at s Hopkins. A death in the family brought me home again in October 2009. I retired and it's been downhill ever since. Being uninsured until July 2012 (Medicare), I was seeing a NP at a local doc-in-a-box to get my prescriptions. I started having days filled with PVCs and depression. I was started back on Doxepin. Labs showed my potassium to be in the 3.0 to 3.2 range, a level that makes me symptomatic. Knowing the cause, I finally just started treating it myself, usually 80-120mEq over a day and a half and I would be okay for a couple of weeks. It was during this time that it registered how often I was urinating. It was so much that I finally bought a meter to check my BS. It was and is normal as is my A1C.I needed a higher level of care so I started seeing the PA at the doc-in-a-box thinking she would be consulting with the in-house doctor regarding my care. After the initial appointment, I was told they would no longer prescribe the Doxepin. The doctor thought I was taking it for sleep or selling it, not sure which. I also needed medication refills. The potassium called in was ½ my normal dose. I freaked because I was almost out and having PVCs again. So I gathered my history `evidence' and took it to the PA. She refused to prescribe the correct amount after I told her I was self-medicating and why with the proof in hand. After an embarrassing tete tete occurring in front of staff and a waiting room full of patients, I stormed out. I asked a friend pull a few strings (doctors won't see you if you're a self-pay I've discovered) and I got in to see a family practice doc in September 2011. Rather than have a staff member record my history incorrectly, I put it in H & P format and handed it to the doctor. While preparing the document, I decided to do some research on the causes of chronic low potassium other than the obvious (thiazide diuretic, albuterol inhaler, and recent rounds of prednisone for pneumonia). Imagine my surprise when Conn's popped up and I finally connected the dots. I am THE POSTER CHILD for Stage IV Conn's. When I had my appointment with the family practice doc, I said, "The bilateral adrenal adenomas are probably functional and it is highly likely that I have Conn's Syndrome". I told him about the low potassium, my symptoms, and how I had been treating it. Much to my surprise and without labs to back up my claim, he prescribed K+ supplements equal to my bi-tri-weekly fix. However, no PA blood or urine labs were ordered and his primary concern was the right renal artery stenosis. The way I viewed that: if my aorta showed calcification in 2000, it is highly likely that the renal artery is also calcified. I thought that was probable because I have been mildly hypercalcemic for years. That I attributed to higher blood calcium levels secondary to CCB therapy. Now I am not so sure.I do have a question: In your Evolution article you state that one of the symptoms of the 34-year-old female was a positive Chevostek and Trousseau. Aren't those tests reflective of low blood calcium? Also, my lab abnormalities are often part of the earth metal/alkaline earth metal periodic family. Is there a correlation other than the valence numbers?Also, a few days a month about an hour after I take my meds, I start feeling light-headed and strange. I know now that the feeling is related to bradycardia and hypotension (HR 50's, BP 80's/30-40's). As the half-life decreases the circulating levels, my HR and BP began looking like my baseline (HR 70's, BP 140-150/80-90). When I feel that way, my radial pulse is almost not palpable. Laying down, of course, helps. So, now I am thinking that, on those days, my aldosterone is suppressed. Am I right?Another thing: Around 2003-4 or so, we started using Nesiritide (atrial natriuretic – ANH stimulator) instead of Dobutrex and Primacor for our CHFers. In the Evolution article, you say that increased vascular pressures promotes natriuresis. So, it follows that these patients have decompensated and no longer respond to the body's compensatory mechanism, correct? Also, does this have something to do with the push for ACE inhibitors as the lead medication in treating HTN?One more question: I am post-menopausal but did have night sweats before menopause that I attributed to hormone levels. I still have night sweats but these are different. I wake up about every two hours. At first I feel almost afraid, my heart starts racing, then I feel completely strange, then I get really hot. The onset of another symptom ends the prior symptom. I've timed it from the fear feeling to the end. It lasts about 4-5 minutes. Then everything returns to normal. This happens most nights sometimes every two hours all night It even happens when I nap. It is what wakes me up. I researched the symptoms and was thinking there was a correlation to LH and FSH based on the q 2 hour cycle. I also considered a release of cortisol. Now I wonder if it is part and parcel of the PA. Any thoughts? Is aldosterone released in intervals? If so, what's the time frame?Finally, of the Stage IV symptoms, these are the ones I've experienced: profound hypokalemia, polyuria, drug resistant HTN, hand/feet/leg cramps, profound weakness, periodic paralysis (onset when I stand but then it subsides in a couple of minutes), arrhythmias, mild proteinuria, and alkaline urine.There is so much more I am probably leaving out, but I am sure you will ask the questions that will free that information. So, thank you for your time and consideration. I'm looking forward to the journey.Barbara TatroMedical History1. Hypertension – DX 1989 - age 42 – Severe and resistant since DX2. Right Renal Artery Stenosis (70%) – 20093. Atrophic right kidney4. Adrenal adenoma – Left 2.2 x 2.5; Right 2.1 x 1.2 Right diagnosed 2-2000 (1.5); Left diagnosed 6-2009 and increased size of right adenoma (described as adrenal nodules)5. Hypokalemia (profound – 1st incidence 1991, documented 2008-2011)6. Mild hypercalcemia7. Hypomagnesemia8. Micro hematuria (small)9. Mild proteinuria10. Aortic calcification11. Heat Intolerance12. Back – T11-12 Central disc extrusion, mild central canal stenosis; L1-2 bulging disc with compression of thecal sac; L2-3 bulging disc compressing thecal sac; L3-4 bulging disc, retroliathesis, central canal stenosis biforaminal stenosis; L4-5 unroofed disc, spondyloliatheses, severe central canal and biforaminal stenosis; L5-S1 extruded disc, left and right foraminal stenosis13. Left hip – joint space narrowing and arthritic changes, subchondral sclerosis (rheumatoid v. osteoarthritis)14. Left lateral leg neuropathy with atrophy15. Falling16. Pneumonia – February, May, September 201117. Bilateral otitis media – February, May, September 201118. COPD19. HPV20. GI bleed – Diffuse gastritis – 2002 secondary to NSAID therapy21. Fuch's Corneal Dystrophy (left eye severe, right eye mild to moderate)22. Basal cell carcinoma left cheek 23. Adenomyosis – D & C x 3 1970's24. Fractures – right tibia, left thumb, spiral fracture right 4th toe25. Seasonal allergies26. Chronic pain27. Depression, anxiety and panic attacks, `nervous breakdown' x3 – first at age 19 – about every 10 years thereafter – last one 198528. Severe childhood abuse and molestation29. Smoker 1ppd x 40 yearsSurgeries1. Exploratory lap, choleycystectomy - 19772. Hysteroscopy – 19953. Removal basal cell carcinoma left cheek – 2000Family History1. Father (deceased) – CHF, multiple MI, multiple CVA, Resistant HTN, Fuch's Corneal Dystrophy, depression, HOH2. Mother (deceased) – HTN, cervical cancer, metastatic cancer 3. Sister (68) – Fuch's corneal dystrophy, depression4. Brother (66) – Bladder cancer, thyroid cancer, HTN, Type II Diabetes, depression5. Brother (60) – HTN, Depression, dysrhythmia6. Brother (46) - Dysrhythmia, depressionAllergies1. Serotonin – Seizure, anaphylaxis, Serotonin Syndrome (ER x3)2. Levaquin – Levaquin Syndrome3. Wellbutrin – Cardiac dysrhythmiaPrevention1. Flu vaccine 11/20122. Pneumonia vaccine 11/2010Medications December - 20111. Lisinopril-Hctz 20/12.5 mg BID2. Verapamil 120mg BID3. Labetalol 200mg BID 4. Pravastatin 20mg Q night5. Doxepin 75mg QD6. ASA 81mg BID7. Potassium 20 mEq BID8. Doxepin 75 mg QD9. Ibuprofen 800mg BID10. Zyrtec 10 mg QD11. Glucosam/Chon 1500/1200mg QD12. Vit B12 1000mcg QD13. Vit C 500mg QD14. Magnesium 250mg BID15. Multi-Vit 1 tab QD16. Fish Oil 1000 mg BID17. Ventolin Inhale 1-2 puffs PRN18. Naproxen 440mg PRN Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 13, 2012 Report Share Posted January 13, 2012 Use iPhone app losit which will track uYour sodium and cAloreiss. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Jan 12, 2012, at 23:03, Barb Tatro <rainbowdayz@...> wrote:  Should clarify. The cheese is Laughing Cow light Swiss. The smoked salmon is 0.5 oz once a day on flat (180mg/2) with the light Swiss. The tuna (180mg) every third day or so. I use no table salt, do not drink anything but water and 1 cup of coffee/day. I season with herbs and lemon only. The bulk of my diet is mostly raw fruits and veggies. No red meat, potatoes, or bread. I will take a closer look at DASH now that I have imbedded. I will make alterations accordingly. Thanks for your insight and input. Barb Re: History/Story What was done if anything about the renal artery? How was the 70% Dxed? Did anyone hear a bruit over that artery? Have you ever taken BCPs? Don't see any renin aldo numbers? How much salt do you eat? Anyone ever mention DASHing? On Jan 11, 2012, at 11:18 PM, amazingkeltic wrote: Dear Dr. Grim,I am a 64-year-old female. I am a retired surgical heart ICU CCRN. I returned to college at age 39, and obtained a BSN. I also student taught A & P and Micro labs for 12 years post-graduation at Indiana University NW. I relocated to Houston, TX in 2001. During my nursing tenure, I worked in community hospitals and for several prestigious institutions including Methodist Hospital, Texas Medical Center, Houston, for and with DeBakey. I also worked for Hazim Safi's AAA unit at Memorial Hermann while in Houston. I have presented at several critical care consortiums and served as clinical educator at many of the facilities where I worked. So… looking back on this medical journey confounds me. I, of all people, should have done the research and found the answer. I attribute part of this phenomenon to the lack of computer skills. I bought my first computer in 2000. I wasn't what I would consider `computer literate' for a few more years. By this time, I was easily 15 years into my PA odyssey and convinced by professionals I trusted that my right adenoma was just an `incidental' finding and quite common. I pride myself in my knowledge base and assessment skills, but I very clearly dropped the ball when it came to me.I do not hold contempt for the doctors who led me astray. If I couldn't see the writing on the wall, why should they. I will say this, in 20+ years of critical care nursing I never once cared for a patient with PA as a primary or secondary diagnosis and I rarely cared for a patient whose home medications included Spironolactone. Fewer still were prescribed Spiro during their hospitalization. The beginning of the end: I was diagnosed with HTN during a routine screening to begin my nursing clinicals (age 42). The person who diagnosed it was an itty bitty nun who was about 104. Poor thing could barely inflate the cuff. Her first reading: 170/104. I assumed the extended inflation time had something to do with it and asked that she repeat it. She did. No change. The doctor that followed confirmed the DX. Begin the litany of BP meds dispensed so conservatively, I am surprised I didn't stroke while waiting. Every change that was made required a waiting period and another visit. Finally, a few years in, I showed some progress. BPs were generally 140-150's/80-90's and that was on a good day. The doc took the standard approach: started with a diuretic then added a CCB, ACE, and finally a b-blocker. See attachment for current medications. The b-blocker was Labetalol. When this was added (due to the alpha blocking), I completely stopped have the adrenalin rushes I had for years – so the offender was nor-epi and not epi? But this created an anti-depressant dilemma: block it with one med, then hold it in the synapse with another… hmmmm… the old come here, go away therapy. Any suggestions because I am on both currently?From age 19 until my diagnosis and treatment for clinical depression in 1985, I had repeated episodes of depression, anxiety attacks, panic attacks, even agoraphobia. When I was finally diagnosed, I was put on Doxepin and have taken it intermittently since that time. My history includes severe child abuse and molestation. So what do I do after I escaped? I, in essence, married my father and the abuse and stress continued. I just kept throwing more logs on the fire. I therefore attributed much of what I was experiencing to my history. I assumed my resistant pressures were anxiety-driven. During this time, I could feel the release of adrenalin. It hit my chest like 360joules. Then the panic and anxiety would ensue. After reading The Evolution, I see that psycho-social stress can produce adenomas. Huge ah-ha moment for this critical care RN. During this time, I suggested a possible pheochromocytoma diagnosis. With the uncontrollable HTN and added microhematuria and mild proteinuria I was beginning to have real concerns. Docs weren't buying that. Too rare. About as rare as PA. But I kept pushing so they started chasing a Lupus diagnosis. The ANA was negative and I was pronounced well, except for the psych issues <sigh>.After graduation (1992), I went to work in a community hospital med/surg ICU. At the same time, we moved and began building the `dream house' we could now afford. My four children were struggling to assimilate into a new environment and school. My oldest daughter was living with us with her baby while her husband served in Desert Storm. All four burners were full up and it wasn't long before I began floundering. One night I went to bed. It felt like me HR was about 200 and I could feel the PVCs. Each one made a pronounce thud in my chest followed by a momentary brain haze. It got so intense I finally asked my husband to take me to the ER. My potassium was 2.7. Their treatment of cure was 20mEq of effervescent potassium po and serial labs. I was released when my K+ hit 3.3. I was pronounced well and they sent me on my way.I scheduled an appointment with my doctor who was still not connecting the dots. He did add 20mEq of K+ daily to my meds. Things stayed pretty much the same. On anti-depressants, then off, uncontrolled HTN, micro hematuria, mild proteinuria, panic, anxiety off and on, same stuff that everyone now considered my normal.We built the house, kids were leaving one-by-one and the marriage had run its course. Divorce was inevitable. During this period, I developed `severe' right flank pain. It felt like if I could stick my finger inside my body up to my hand at the level of my inferior rib, I could touch where the pain was located. Now I get it. My doctor gave me some Vicodin which helped but I was miserable, couldn't find a comfortable position and it went on for 2 months. At that time he ordered a CT of my chest. God only knows why. The right adrenal adenoma (or nodule as it was described) was uncovered. Still not connecting the dots, him or me. That year I divorced and relocated to Houston. I was happier and felt healthier. I was even able to wean down my anti-hypertensives. This is when the issues with my back began and the introduction of daily NSAIDs. It is now a concern for me because I know there is an issue with combining NSAIDs and Spiro. Your thoughts?More life changes. I moved back to Chicago October 2004 and decided to give my failed marriage a second chance. It was less stressful than it had been, but still acceptable. Soon, I started having a lot of PVCs again. I was at work one night and decided to run a strip to see if these were PACs of PVCs. They were PVCs (bigeminy, trigeminy, and random). I had a nurse friend draw some blood and we sent it to lab. My potassium was 2.8. I called the pharmacy and they sent me 100 mEq of K+. It suppressed the PVCs for a few days but they returned. Again, I ran a strip, drew blood, K+ was 3.0. Sent for a supplement and went to the clinic. The doctor I had always seen left the Clinic, so I no longer had a doctor. An Immediate Care physician saw me. He ordered a 24-hr Holter and labs. The PVCs were ridiculously high. I know. I could feel every one. But nothing was done. No follow-up, consultations, referrals, or treatment.Things were deteriorating rapidly with the current living situation, so I moved out. I began having severe lower leg and feet cramps in 2008. I also was having frequent lower leg fasciculations, particularly when I'd lay down. I started taking B12 for the cramping which helped quite a bit. In January 2009 I moved to polis, MD to take a job at s Hopkins. A death in the family brought me home again in October 2009. I retired and it's been downhill ever since. Being uninsured until July 2012 (Medicare), I was seeing a NP at a local doc-in-a-box to get my prescriptions. I started having days filled with PVCs and depression. I was started back on Doxepin. Labs showed my potassium to be in the 3.0 to 3.2 range, a level that makes me symptomatic. Knowing the cause, I finally just started treating it myself, usually 80-120mEq over a day and a half and I would be okay for a couple of weeks. It was during this time that it registered how often I was urinating. It was so much that I finally bought a meter to check my BS. It was and is normal as is my A1C.I needed a higher level of care so I started seeing the PA at the doc-in-a-box thinking she would be consulting with the in-house doctor regarding my care. After the initial appointment, I was told they would no longer prescribe the Doxepin. The doctor thought I was taking it for sleep or selling it, not sure which. I also needed medication refills. The potassium called in was ½ my normal dose. I freaked because I was almost out and having PVCs again. So I gathered my history `evidence' and took it to the PA. She refused to prescribe the correct amount after I told her I was self-medicating and why with the proof in hand. After an embarrassing tete tete occurring in front of staff and a waiting room full of patients, I stormed out. I asked a friend pull a few strings (doctors won't see you if you're a self-pay I've discovered) and I got in to see a family practice doc in September 2011. Rather than have a staff member record my history incorrectly, I put it in H & P format and handed it to the doctor. While preparing the document, I decided to do some research on the causes of chronic low potassium other than the obvious (thiazide diuretic, albuterol inhaler, and recent rounds of prednisone for pneumonia). Imagine my surprise when Conn's popped up and I finally connected the dots. I am THE POSTER CHILD for Stage IV Conn's. When I had my appointment with the family practice doc, I said, "The bilateral adrenal adenomas are probably functional and it is highly likely that I have Conn's Syndrome". I told him about the low potassium, my symptoms, and how I had been treating it. Much to my surprise and without labs to back up my claim, he prescribed K+ supplements equal to my bi-tri-weekly fix. However, no PA blood or urine labs were ordered and his primary concern was the right renal artery stenosis. The way I viewed that: if my aorta showed calcification in 2000, it is highly likely that the renal artery is also calcified. I thought that was probable because I have been mildly hypercalcemic for years. That I attributed to higher blood calcium levels secondary to CCB therapy. Now I am not so sure.I do have a question: In your Evolution article you state that one of the symptoms of the 34-year-old female was a positive Chevostek and Trousseau. Aren't those tests reflective of low blood calcium? Also, my lab abnormalities are often part of the earth metal/alkaline earth metal periodic family. Is there a correlation other than the valence numbers?Also, a few days a month about an hour after I take my meds, I start feeling light-headed and strange. I know now that the feeling is related to bradycardia and hypotension (HR 50's, BP 80's/30-40's). As the half-life decreases the circulating levels, my HR and BP began looking like my baseline (HR 70's, BP 140-150/80-90). When I feel that way, my radial pulse is almost not palpable. Laying down, of course, helps. So, now I am thinking that, on those days, my aldosterone is suppressed. Am I right?Another thing: Around 2003-4 or so, we started using Nesiritide (atrial natriuretic – ANH stimulator) instead of Dobutrex and Primacor for our CHFers. In the Evolution article, you say that increased vascular pressures promotes natriuresis. So, it follows that these patients have decompensated and no longer respond to the body's compensatory mechanism, correct? Also, does this have something to do with the push for ACE inhibitors as the lead medication in treating HTN?One more question: I am post-menopausal but did have night sweats before menopause that I attributed to hormone levels. I still have night sweats but these are different. I wake up about every two hours. At first I feel almost afraid, my heart starts racing, then I feel completely strange, then I get really hot. The onset of another symptom ends the prior symptom. I've timed it from the fear feeling to the end. It lasts about 4-5 minutes. Then everything returns to normal. This happens most nights sometimes every two hours all night It even happens when I nap. It is what wakes me up. I researched the symptoms and was thinking there was a correlation to LH and FSH based on the q 2 hour cycle. I also considered a release of cortisol. Now I wonder if it is part and parcel of the PA. Any thoughts? Is aldosterone released in intervals? If so, what's the time frame?Finally, of the Stage IV symptoms, these are the ones I've experienced: profound hypokalemia, polyuria, drug resistant HTN, hand/feet/leg cramps, profound weakness, periodic paralysis (onset when I stand but then it subsides in a couple of minutes), arrhythmias, mild proteinuria, and alkaline urine.There is so much more I am probably leaving out, but I am sure you will ask the questions that will free that information. So, thank you for your time and consideration. I'm looking forward to the journey.Barbara TatroMedical History1. Hypertension – DX 1989 - age 42 – Severe and resistant since DX2. Right Renal Artery Stenosis (70%) – 20093. Atrophic right kidney4. Adrenal adenoma – Left 2.2 x 2.5; Right 2.1 x 1.2 Right diagnosed 2-2000 (1.5); Left diagnosed 6-2009 and increased size of right adenoma (described as adrenal nodules)5. Hypokalemia (profound – 1st incidence 1991, documented 2008-2011)6. Mild hypercalcemia7. Hypomagnesemia8. Micro hematuria (small)9. Mild proteinuria10. Aortic calcification11. Heat Intolerance12. Back – T11-12 Central disc extrusion, mild central canal stenosis; L1-2 bulging disc with compression of thecal sac; L2-3 bulging disc compressing thecal sac; L3-4 bulging disc, retroliathesis, central canal stenosis biforaminal stenosis; L4-5 unroofed disc, spondyloliatheses, severe central canal and biforaminal stenosis; L5-S1 extruded disc, left and right foraminal stenosis13. Left hip – joint space narrowing and arthritic changes, subchondral sclerosis (rheumatoid v. osteoarthritis)14. Left lateral leg neuropathy with atrophy15. Falling16. Pneumonia – February, May, September 201117. Bilateral otitis media – February, May, September 201118. COPD19. HPV20. GI bleed – Diffuse gastritis – 2002 secondary to NSAID therapy21. Fuch's Corneal Dystrophy (left eye severe, right eye mild to moderate)22. Basal cell carcinoma left cheek 23. Adenomyosis – D & C x 3 1970's24. Fractures – right tibia, left thumb, spiral fracture right 4th toe25. Seasonal allergies26. Chronic pain27. Depression, anxiety and panic attacks, `nervous breakdown' x3 – first at age 19 – about every 10 years thereafter – last one 198528. Severe childhood abuse and molestation29. Smoker 1ppd x 40 yearsSurgeries1. Exploratory lap, choleycystectomy - 19772. Hysteroscopy – 19953. Removal basal cell carcinoma left cheek – 2000Family History1. Father (deceased) – CHF, multiple MI, multiple CVA, Resistant HTN, Fuch's Corneal Dystrophy, depression, HOH2. Mother (deceased) – HTN, cervical cancer, metastatic cancer 3. Sister (68) – Fuch's corneal dystrophy, depression4. Brother (66) – Bladder cancer, thyroid cancer, HTN, Type II Diabetes, depression5. Brother (60) – HTN, Depression, dysrhythmia6. Brother (46) - Dysrhythmia, depressionAllergies1. Serotonin – Seizure, anaphylaxis, Serotonin Syndrome (ER x3)2. Levaquin – Levaquin Syndrome3. Wellbutrin – Cardiac dysrhythmiaPrevention1. Flu vaccine 11/20122. Pneumonia vaccine 11/2010Medications December - 20111. Lisinopril-Hctz 20/12.5 mg BID2. Verapamil 120mg BID3. Labetalol 200mg BID 4. Pravastatin 20mg Q night5. Doxepin 75mg QD6. ASA 81mg BID7. Potassium 20 mEq BID8. Doxepin 75 mg QD9. Ibuprofen 800mg BID10. Zyrtec 10 mg QD11. Glucosam/Chon 1500/1200mg QD12. Vit B12 1000mcg QD13. Vit C 500mg QD14. Magnesium 250mg BID15. Multi-Vit 1 tab QD16. Fish Oil 1000 mg BID17. Ventolin Inhale 1-2 puffs PRN18. Naproxen 440mg PRN Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 13, 2012 Report Share Posted January 13, 2012 Hi Barbara, Welcome to the group. As one who has seen great results following the DASH diet, I would strongly encourage you to get the DASH book. This is not just a low salt diet, but one that is also high potassium. The focus is to be under 1500 mg Na and at about 4800 mg K. Keeping a log at the beginning also helps. This is a very important first step in getting PA under control. 51yo wf, suspected early PA, extremely labile bp under control with DASHing under 500 mg Na, previous nocturia up to 6x now under control at 1-2x, elevated hhv-6 antibodies, elevated bilirubin, elevated ferritin, low platelets, toxic mold exposure, multiple chemical sensitivity, possible Lyme, food allergies > > > > > >>Dear Dr. Grim, > >> > >>I am a 64-year-old female. I am a retired surgical > heart ICU CCRN. I returned to college at age 39, and obtained a BSN. I also > student taught A & P and Micro labs for 12 years post-graduation at > Indiana University NW. I relocated to Houston, TX in 2001. During my nursing > tenure, I worked in community hospitals and for several prestigious > institutions including Methodist Hospital, Texas Medical Center, Houston, > for and with DeBakey. I also worked for Hazim Safi's AAA unit at > Memorial Hermann while in Houston. I have presented at several critical care > consortiums and served as clinical educator at many of the facilities where > I worked. > >> > >>So… looking back on this medical journey confounds me. I, > of all people, should have done the research and found the answer. I > attribute part of this phenomenon to the lack of computer skills. I bought > my first computer in 2000. I wasn't what I would consider `computer > literate' for a few more years. By this time, I was easily 15 years into my > PA odyssey and convinced by professionals I trusted that my right adenoma > was just an `incidental' finding and quite common. I pride myself in my > knowledge base and assessment skills, but I very clearly dropped the ball > when it came to me. > >> > >>I do not hold contempt for the doctors who led me > astray. If I couldn't see the writing on the wall, why should they. I will > say this, in 20+ years of critical care nursing I never once cared for a > patient with PA as a primary or secondary diagnosis and I rarely cared for a > patient whose home medications included Spironolactone. Fewer still were > prescribed Spiro during their hospitalization. > >> > >>The beginning of the > end: I was diagnosed with HTN during a routine screening to begin my nursing > clinicals (age 42). The person who diagnosed it was an itty bitty nun who > was about 104. Poor thing could barely inflate the cuff. Her first reading: > 170/104. I assumed the extended inflation time had something to do with it > and asked that she repeat it. She did. No change. The doctor that followed > confirmed the DX. Begin the litany of BP meds dispensed so conservatively, I > am surprised I didn't stroke while waiting. Every change that was made > required a waiting period and another visit. Finally, a few years in, I > showed some progress. BPs were generally 140-150's/80-90's and that was on a > good day. The doc took the standard approach: started with a diuretic then > added a CCB, ACE, and finally a b-blocker. See attachment for current > medications. The b-blocker was Labetalol. When this was added (due to the > alpha blocking), I completely stopped have the adrenalin rushes I had for > years †" so the offender was nor-epi and not epi? But this created an > anti-depressant dilemma: block it with one med, then hold it in the synapse > with another… hmmmm… the old come here, go away therapy. Any suggestions > because I am on both currently? > >> > >>From age 19 until my diagnosis and > treatment for clinical depression in 1985, I had repeated episodes of > depression, anxiety attacks, panic attacks, even agoraphobia. When I was > finally diagnosed, I was put on Doxepin and have taken it intermittently > since that time. My history includes severe child abuse and molestation. So > what do I do after I escaped? I, in essence, married my father and the abuse > and stress continued. I just kept throwing more logs on the fire. I > therefore attributed much of what I was experiencing to my history. I > assumed my resistant pressures were anxiety-driven. During this time, I > could feel the release of adrenalin. It hit my chest like 360joules. Then > the panic and anxiety would ensue. After reading The Evolution, I see that > psycho-social stress can produce adenomas. Huge ah-ha moment for this > critical care RN. > >> > >>During this time, I suggested a possible > pheochromocytoma diagnosis. With the uncontrollable HTN and added > microhematuria and mild proteinuria I was beginning to have real concerns. > Docs weren't buying that. Too rare. About as rare as PA. But I kept pushing > so they started chasing a Lupus diagnosis. The ANA was negative and I was > pronounced well, except for the psych issues <sigh>. > >> > >>After > graduation (1992), I went to work in a community hospital med/surg ICU. At > the same time, we moved and began building the `dream house' we could now > afford. My four children were struggling to assimilate into a new > environment and school. My oldest daughter was living with us with her baby > while her husband served in Desert Storm. All four burners were full up and > it wasn't long before I began floundering. One night I went to bed. It felt > like me HR was about 200 and I could feel the PVCs. Each one made a > pronounce thud in my chest followed by a momentary brain haze. It got so > intense I finally asked my husband to take me to the ER. My potassium was > 2.7. Their treatment of cure was 20mEq of effervescent potassium po and > serial labs. I was released when my K+ hit 3.3. I was pronounced well and > they sent me on my way. > >> > >>I scheduled an appointment with my doctor who > was still not connecting the dots. He did add 20mEq of K+ daily to my meds. > Things stayed pretty much the same. On anti-depressants, then off, > uncontrolled HTN, micro hematuria, mild proteinuria, panic, anxiety off and > on, same stuff that everyone now considered my normal. > >> > >>We built the > house, kids were leaving one-by-one and the marriage had run its course. > Divorce was inevitable. During this period, I developed `severe' right flank > pain. It felt like if I could stick my finger inside my body up to my hand > at the level of my inferior rib, I could touch where the pain was located. > Now I get it. My doctor gave me some Vicodin which helped but I was > miserable, couldn't find a comfortable position and it went on for 2 months. > At that time he ordered a CT of my chest. God only knows why. The right > adrenal adenoma (or nodule as it was described) was uncovered. Still not > connecting the dots, him or me. > >> > >>That year I divorced and relocated > to Houston. I was happier and felt healthier. I was even able to wean down > my anti-hypertensives. This is when the issues with my back began and the > introduction of daily NSAIDs. It is now a concern for me because I know > there is an issue with combining NSAIDs and Spiro. Your > thoughts? > >> > >>More life changes. I moved back to Chicago October 2004 and > decided to give my failed marriage a second chance. It was less stressful > than it had been, but still acceptable. Soon, I started having a lot of PVCs > again. I was at work one night and decided to run a strip to see if these > were PACs of PVCs. They were PVCs (bigeminy, trigeminy, and random). I had a > nurse friend draw some blood and we sent it to lab. My potassium was 2.8. I > called the pharmacy and they sent me 100 mEq of K+. It suppressed the PVCs > for a few days but they returned. Again, I ran a strip, drew blood, K+ was > 3.0. Sent for a supplement and went to the clinic. The doctor I had always > seen left the Clinic, so I no longer had a doctor. An Immediate Care > physician saw me. He ordered a 24-hr Holter and labs. The PVCs were > ridiculously high. I know. I could feel every one. But nothing was done. No > follow-up, consultations, referrals, or treatment. > >> > >>Things were > deteriorating rapidly with the current living situation, so I moved out. I > began having severe lower leg and feet cramps in 2008. I also was having > frequent lower leg fasciculations, particularly when I'd lay down. I started > taking B12 for the cramping which helped quite a bit. In January 2009 I > moved to polis, MD to take a job at s Hopkins. A death in the family > brought me home again in October 2009. I retired and it's been downhill ever > since. > >> > >>Being uninsured until July 2012 (Medicare), I was seeing a NP > at a local doc-in-a-box to get my prescriptions. I started having days > filled with PVCs and depression. I was started back on Doxepin. Labs showed > my potassium to be in the 3.0 to 3.2 range, a level that makes me > symptomatic. Knowing the cause, I finally just started treating it myself, > usually 80-120mEq over a day and a half and I would be okay for a couple of > weeks. It was during this time that it registered how often I was urinating. > It was so much that I finally bought a meter to check my BS. It was and is > normal as is my A1C. > >> > >>I needed a higher level of care so I started > seeing the PA at the doc-in-a-box thinking she would be consulting with the > in-house doctor regarding my care. After the initial appointment, I was told > they would no longer prescribe the Doxepin. The doctor thought I was taking > it for sleep or selling it, not sure which. I also needed medication > refills. The potassium called in was ½ my normal dose. I freaked because I > was almost out and having PVCs again. So I gathered my history `evidence' > and took it to the PA. She refused to prescribe the correct amount after I > told her I was self-medicating and why with the proof in hand. After an > embarrassing tete tete occurring in front of staff and a waiting room full > of patients, I stormed out. I asked a friend pull a few strings (doctors > won't see you if you're a self-pay I've discovered) and I got in to see a > family practice doc in September 2011. > >> > >>Rather than have a staff > member record my history incorrectly, I put it in H & P format and handed > it to the doctor. While preparing the document, I decided to do some > research on the causes of chronic low potassium other than the obvious > (thiazide diuretic, albuterol inhaler, and recent rounds of prednisone for > pneumonia). Imagine my surprise when Conn's popped up and I finally > connected the dots. I am THE POSTER CHILD for Stage IV Conn's. > >> > >>When > I had my appointment with the family practice doc, I said, " The bilateral > adrenal adenomas are probably functional and it is highly likely that I have > Conn's Syndrome " . I told him about the low potassium, my symptoms, and how I > had been treating it. Much to my surprise and without labs to back up my > claim, he prescribed K+ supplements equal to my bi-tri-weekly fix. However, > no PA blood or urine labs were ordered and his primary concern was the right > renal artery stenosis. The way I viewed that: if my aorta showed > calcification in 2000, it is highly likely that the renal artery is also > calcified. I thought that was probable because I have been mildly > hypercalcemic for years. That I attributed to higher blood calcium levels > secondary to CCB therapy. Now I am not so sure. > >> > >>I do have a question: > In your Evolution article you state that one of the symptoms of the > 34-year-old female was a positive Chevostek and Trousseau. Aren't those > tests reflective of low blood calcium? Also, my lab abnormalities are often > part of the earth metal/alkaline earth metal periodic family. Is there a > correlation other than the valence numbers? > >> > >>Also, a few days a month > about an hour after I take my meds, I start feeling light-headed and > strange. I know now that the feeling is related to bradycardia and > hypotension (HR 50's, BP 80's/30-40's). As the half-life decreases the > circulating levels, my HR and BP began looking like my baseline (HR 70's, BP > 140-150/80-90). When I feel that way, my radial pulse is almost not > palpable. Laying down, of course, helps. So, now I am thinking that, on > those days, my aldosterone is suppressed. Am I right? > >> > >>Another thing: > Around 2003-4 or so, we started using Nesiritide (atrial natriuretic †" ANH > stimulator) instead of Dobutrex and Primacor for our CHFers. In the > Evolution article, you say that increased vascular pressures promotes > natriuresis. So, it follows that these patients have decompensated and no > longer respond to the body's compensatory mechanism, correct? Also, does > this have something to do with the push for ACE inhibitors as the lead > medication in treating HTN? > >> > >>One more question: I am post-menopausal > but did have night sweats before menopause that I attributed to hormone > levels. I still have night sweats but these are different. I wake up about > every two hours. At first I feel almost afraid, my heart starts racing, then > I feel completely strange, then I get really hot. The onset of another > symptom ends the prior symptom. I've timed it from the fear feeling to the > end. It lasts about 4-5 minutes. Then everything returns to normal. This > happens most nights sometimes every two hours all night It even happens when > I nap. It is what wakes me up. I researched the symptoms and was thinking > there was a correlation to LH and FSH based on the q 2 hour cycle. I also > considered a release of cortisol. Now I wonder if it is part and parcel of > the PA. Any thoughts? Is aldosterone released in intervals? If so, what's > the time frame? > >> > >>Finally, of the Stage IV symptoms, these are the ones > I've experienced: profound hypokalemia, polyuria, drug resistant HTN, > hand/feet/leg cramps, profound weakness, periodic paralysis (onset when I > stand but then it subsides in a couple of minutes), arrhythmias, mild > proteinuria, and alkaline urine. > >> > >>There is so much more I am probably > leaving out, but I am sure you will ask the questions that will free that > information. So, thank you for your time and consideration. I'm looking > forward to the journey. > >> > >>Barbara Tatro > >> > >>Medical > History > >> > >>1. Hypertension †" DX 1989 - age 42 †" Severe and resistant > since DX > >>2. Right Renal Artery Stenosis (70%) †" 2009 > >>3. Atrophic right > kidney > >>4. Adrenal adenoma †" Left 2.2 x 2.5; Right 2.1 x 1.2 > >>Right > diagnosed 2-2000 (1.5); Left diagnosed 6-2009 and increased size of right > adenoma (described as adrenal nodules) > >>5. Hypokalemia (profound †" 1st > incidence 1991, documented 2008-2011) > >>6. Mild hypercalcemia > >>7. > Hypomagnesemia > >>8. Micro hematuria (small) > >>9. Mild proteinuria > >>10. > Aortic calcification > >>11. Heat Intolerance > >>12. Back †" T11-12 Central > disc extrusion, mild central canal stenosis; L1-2 bulging disc with > compression of thecal sac; L2-3 bulging disc compressing thecal sac; L3-4 > bulging disc, retroliathesis, central canal stenosis biforaminal stenosis; > L4-5 unroofed disc, spondyloliatheses, severe central canal and biforaminal > stenosis; L5-S1 extruded disc, left and right foraminal stenosis > >>13. Left > hip †" joint space narrowing and arthritic changes, subchondral sclerosis > (rheumatoid v. osteoarthritis) > >>14. Left lateral leg neuropathy with > atrophy > >>15. Falling > >>16. Pneumonia †" February, May, September > 2011 > >>17. Bilateral otitis media †" February, May, September 2011 > >>18. > COPD > >>19. HPV > >>20. GI bleed †" Diffuse gastritis †" 2002 secondary to > NSAID therapy > >>21. Fuch's Corneal Dystrophy (left eye severe, right eye > mild to moderate) > >>22. Basal cell carcinoma left cheek > >>23. Adenomyosis > †" D & C x 3 1970's > >>24. Fractures †" right tibia, left thumb, spiral > fracture right 4th toe > >>25. Seasonal allergies > >>26. Chronic pain > >>27. > Depression, anxiety and panic attacks, `nervous breakdown' x3 †" first at age > 19 †" about every 10 years thereafter †" last one 1985 > >>28. Severe childhood > abuse and molestation > >>29. Smoker 1ppd x 40 years > >> > >>Surgeries > >>1. > Exploratory lap, choleycystectomy - 1977 > >>2. Hysteroscopy †" 1995 > >>3. > Removal basal cell carcinoma left cheek †" 2000 > >> > >>Family History > >>1. > Father (deceased) †" CHF, multiple MI, multiple CVA, Resistant HTN, Fuch's > Corneal Dystrophy, depression, HOH > >>2. Mother (deceased) †" HTN, cervical > cancer, metastatic cancer > >>3. Sister (68) †" Fuch's corneal dystrophy, > depression > >>4. Brother (66) †" Bladder cancer, thyroid cancer, HTN, Type II > Diabetes, depression > >>5. Brother (60) †" HTN, Depression, dysrhythmia > >>6. > Brother (46) - Dysrhythmia, depression > >> > >>Allergies > >>1. Serotonin †" > Seizure, anaphylaxis, Serotonin Syndrome (ER x3) > >>2. Levaquin †" Levaquin > Syndrome > >>3. Wellbutrin †" Cardiac dysrhythmia > >> > >>Prevention > >>1. Flu > vaccine 11/2012 > >>2. Pneumonia vaccine 11/2010 > >> > >>Medications December > - 2011 > >> > >>1. Lisinopril-Hctz 20/12.5 mg BID > >>2. Verapamil 120mg > BID > >>3. Labetalol 200mg BID > >>4. Pravastatin 20mg Q night > >>5. Doxepin > 75mg QD > >>6. ASA 81mg BID > >>7. Potassium 20 mEq BID > >>8. Doxepin 75 mg > QD > >>9. Ibuprofen 800mg BID > >>10. Zyrtec 10 mg QD > >>11. Glucosam/Chon > 1500/1200mg QD > >>12. Vit B12 1000mcg QD > >>13. Vit C 500mg QD > >>14. > Magnesium 250mg BID > >>15. Multi-Vit 1 tab QD > >>16. Fish Oil 1000 mg > BID > >>17. Ventolin Inhale 1-2 puffs PRN > >>18. Naproxen 440mg > PRN > >> > >> > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 13, 2012 Report Share Posted January 13, 2012 Hi , Will do. Barbara Re: History/Story Hi Barbara,Welcome to the group. As one who has seen great results following the DASH diet, I would strongly encourage you to get the DASH book. This is not just a low salt diet, but one that is also high potassium. The focus is to be under 1500 mg Na and at about 4800 mg K. Keeping a log at the beginning also helps. This is a very important first step in getting PA under control.51yo wf, suspected early PA, extremely labile bp under control with DASHing under 500 mg Na, previous nocturia up to 6x now under control at 1-2x, elevated hhv-6 antibodies, elevated bilirubin, elevated ferritin, low platelets, toxic mold exposure, multiple chemical sensitivity, possible Lyme, food allergies> >> > > >>Dear Dr. Grim,> >>> >>I am a 64-year-old female. I am a retired surgical > heart ICU CCRN. I returned to college at age 39, and obtained a BSN. I also > student taught A & P and Micro labs for 12 years post-graduation at > Indiana University NW. I relocated to Houston, TX in 2001. During my nursing > tenure, I worked in community hospitals and for several prestigious > institutions including Methodist Hospital, Texas Medical Center, Houston, > for and with DeBakey. I also worked for Hazim Safi's AAA unit at > Memorial Hermann while in Houston. I have presented at several critical care > consortiums and served as clinical educator at many of the facilities where > I worked. > >>> >>Soâ?¦ looking back on this medical journey confounds me. I, > of all people, should have done the research and found the answer. I > attribute part of this phenomenon to the lack of computer skills. I bought > my first computer in 2000. I wasn't what I would consider `computer > literate' for a few more years. By this time, I was easily 15 years into my > PA odyssey and convinced by professionals I trusted that my right adenoma > was just an `incidental' finding and quite common. I pride myself in my > knowledge base and assessment skills, but I very clearly dropped the ball > when it came to me.> >>> >>I do not hold contempt for the doctors who led me > astray. If I couldn't see the writing on the wall, why should they. I will > say this, in 20+ years of critical care nursing I never once cared for a > patient with PA as a primary or secondary diagnosis and I rarely cared for a > patient whose home medications included Spironolactone. Fewer still were > prescribed Spiro during their hospitalization. > >>> >>The beginning of the > end: I was diagnosed with HTN during a routine screening to begin my nursing > clinicals (age 42). The person who diagnosed it was an itty bitty nun who > was about 104. Poor thing could barely inflate the cuff. Her first reading: > 170/104. I assumed the extended inflation time had something to do with it > and asked that she repeat it. She did. No change. The doctor that followed > confirmed the DX. Begin the litany of BP meds dispensed so conservatively, I > am surprised I didn't stroke while waiting. Every change that was made > required a waiting period and another visit. Finally, a few years in, I > showed some progress. BPs were generally 140-150's/80-90's and that was on a > good day. The doc took the standard approach: started with a diuretic then > added a CCB, ACE, and finally a b-blocker. See attachment for current > medications. The b-blocker was Labetalol. When this was added (due to the > alpha blocking), I completely stopped have the adrenalin rushes I had for > years â?" so the offender was nor-epi and not epi? But this created an > anti-depressant dilemma: block it with one med, then hold it in the synapse > with anotherâ?¦ hmmmmâ?¦ the old come here, go away therapy. Any suggestions > because I am on both currently?> >>> >>From age 19 until my diagnosis and > treatment for clinical depression in 1985, I had repeated episodes of > depression, anxiety attacks, panic attacks, even agoraphobia. When I was > finally diagnosed, I was put on Doxepin and have taken it intermittently > since that time. My history includes severe child abuse and molestation. So > what do I do after I escaped? I, in essence, married my father and the abuse > and stress continued. I just kept throwing more logs on the fire. I > therefore attributed much of what I was experiencing to my history. I > assumed my resistant pressures were anxiety-driven. During this time, I > could feel the release of adrenalin. It hit my chest like 360joules. Then > the panic and anxiety would ensue. After reading The Evolution, I see that > psycho-social stress can produce adenomas. Huge ah-ha moment for this > critical care RN. > >>> >>During this time, I suggested a possible > pheochromocytoma diagnosis. With the uncontrollable HTN and added > microhematuria and mild proteinuria I was beginning to have real concerns. > Docs weren't buying that. Too rare. About as rare as PA. But I kept pushing > so they started chasing a Lupus diagnosis. The ANA was negative and I was > pronounced well, except for the psych issues <sigh>.> >>> >>After > graduation (1992), I went to work in a community hospital med/surg ICU. At > the same time, we moved and began building the `dream house' we could now > afford. My four children were struggling to assimilate into a new > environment and school. My oldest daughter was living with us with her baby > while her husband served in Desert Storm. All four burners were full up and > it wasn't long before I began floundering. One night I went to bed. It felt > like me HR was about 200 and I could feel the PVCs. Each one made a > pronounce thud in my chest followed by a momentary brain haze. It got so > intense I finally asked my husband to take me to the ER. My potassium was > 2.7. Their treatment of cure was 20mEq of effervescent potassium po and > serial labs. I was released when my K+ hit 3.3. I was pronounced well and > they sent me on my way.> >>> >>I scheduled an appointment with my doctor who > was still not connecting the dots. He did add 20mEq of K+ daily to my meds. > Things stayed pretty much the same. On anti-depressants, then off, > uncontrolled HTN, micro hematuria, mild proteinuria, panic, anxiety off and > on, same stuff that everyone now considered my normal.> >>> >>We built the > house, kids were leaving one-by-one and the marriage had run its course. > Divorce was inevitable. During this period, I developed `severe' right flank > pain. It felt like if I could stick my finger inside my body up to my hand > at the level of my inferior rib, I could touch where the pain was located. > Now I get it. My doctor gave me some Vicodin which helped but I was > miserable, couldn't find a comfortable position and it went on for 2 months. > At that time he ordered a CT of my chest. God only knows why. The right > adrenal adenoma (or nodule as it was described) was uncovered. Still not > connecting the dots, him or me. > >>> >>That year I divorced and relocated > to Houston. I was happier and felt healthier. I was even able to wean down > my anti-hypertensives. This is when the issues with my back began and the > introduction of daily NSAIDs. It is now a concern for me because I know > there is an issue with combining NSAIDs and Spiro. Your > thoughts?> >>> >>More life changes. I moved back to Chicago October 2004 and > decided to give my failed marriage a second chance. It was less stressful > than it had been, but still acceptable. Soon, I started having a lot of PVCs > again. I was at work one night and decided to run a strip to see if these > were PACs of PVCs. They were PVCs (bigeminy, trigeminy, and random). I had a > nurse friend draw some blood and we sent it to lab. My potassium was 2.8. I > called the pharmacy and they sent me 100 mEq of K+. It suppressed the PVCs > for a few days but they returned. Again, I ran a strip, drew blood, K+ was > 3.0. Sent for a supplement and went to the clinic. The doctor I had always > seen left the Clinic, so I no longer had a doctor. An Immediate Care > physician saw me. He ordered a 24-hr Holter and labs. The PVCs were > ridiculously high. I know. I could feel every one. But nothing was done. No > follow-up, consultations, referrals, or treatment.> >>> >>Things were > deteriorating rapidly with the current living situation, so I moved out. I > began having severe lower leg and feet cramps in 2008. I also was having > frequent lower leg fasciculations, particularly when I'd lay down. I started > taking B12 for the cramping which helped quite a bit. In January 2009 I > moved to polis, MD to take a job at s Hopkins. A death in the family > brought me home again in October 2009. I retired and it's been downhill ever > since. > >>> >>Being uninsured until July 2012 (Medicare), I was seeing a NP > at a local doc-in-a-box to get my prescriptions. I started having days > filled with PVCs and depression. I was started back on Doxepin. Labs showed > my potassium to be in the 3.0 to 3.2 range, a level that makes me > symptomatic. Knowing the cause, I finally just started treating it myself, > usually 80-120mEq over a day and a half and I would be okay for a couple of > weeks. It was during this time that it registered how often I was urinating. > It was so much that I finally bought a meter to check my BS. It was and is > normal as is my A1C.> >>> >>I needed a higher level of care so I started > seeing the PA at the doc-in-a-box thinking she would be consulting with the > in-house doctor regarding my care. After the initial appointment, I was told > they would no longer prescribe the Doxepin. The doctor thought I was taking > it for sleep or selling it, not sure which. I also needed medication > refills. The potassium called in was ½ my normal dose. I freaked because I > was almost out and having PVCs again. So I gathered my history `evidence' > and took it to the PA. She refused to prescribe the correct amount after I > told her I was self-medicating and why with the proof in hand. After an > embarrassing tete tete occurring in front of staff and a waiting room full > of patients, I stormed out. I asked a friend pull a few strings (doctors > won't see you if you're a self-pay I've discovered) and I got in to see a > family practice doc in September 2011. > >>> >>Rather than have a staff > member record my history incorrectly, I put it in H & P format and handed > it to the doctor. While preparing the document, I decided to do some > research on the causes of chronic low potassium other than the obvious > (thiazide diuretic, albuterol inhaler, and recent rounds of prednisone for > pneumonia). Imagine my surprise when Conn's popped up and I finally > connected the dots. I am THE POSTER CHILD for Stage IV Conn's. > >>> >>When > I had my appointment with the family practice doc, I said, "The bilateral > adrenal adenomas are probably functional and it is highly likely that I have > Conn's Syndrome". I told him about the low potassium, my symptoms, and how I > had been treating it. Much to my surprise and without labs to back up my > claim, he prescribed K+ supplements equal to my bi-tri-weekly fix. However, > no PA blood or urine labs were ordered and his primary concern was the right > renal artery stenosis. The way I viewed that: if my aorta showed > calcification in 2000, it is highly likely that the renal artery is also > calcified. I thought that was probable because I have been mildly > hypercalcemic for years. That I attributed to higher blood calcium levels > secondary to CCB therapy. Now I am not so sure.> >>> >>I do have a question: > In your Evolution article you state that one of the symptoms of the > 34-year-old female was a positive Chevostek and Trousseau. Aren't those > tests reflective of low blood calcium? Also, my lab abnormalities are often > part of the earth metal/alkaline earth metal periodic family. Is there a > correlation other than the valence numbers?> >>> >>Also, a few days a month > about an hour after I take my meds, I start feeling light-headed and > strange. I know now that the feeling is related to bradycardia and > hypotension (HR 50's, BP 80's/30-40's). As the half-life decreases the > circulating levels, my HR and BP began looking like my baseline (HR 70's, BP > 140-150/80-90). When I feel that way, my radial pulse is almost not > palpable. Laying down, of course, helps. So, now I am thinking that, on > those days, my aldosterone is suppressed. Am I right?> >>> >>Another thing: > Around 2003-4 or so, we started using Nesiritide (atrial natriuretic â?" ANH > stimulator) instead of Dobutrex and Primacor for our CHFers. In the > Evolution article, you say that increased vascular pressures promotes > natriuresis. So, it follows that these patients have decompensated and no > longer respond to the body's compensatory mechanism, correct? Also, does > this have something to do with the push for ACE inhibitors as the lead > medication in treating HTN?> >>> >>One more question: I am post-menopausal > but did have night sweats before menopause that I attributed to hormone > levels. I still have night sweats but these are different. I wake up about > every two hours. At first I feel almost afraid, my heart starts racing, then > I feel completely strange, then I get really hot. The onset of another > symptom ends the prior symptom. I've timed it from the fear feeling to the > end. It lasts about 4-5 minutes. Then everything returns to normal. This > happens most nights sometimes every two hours all night It even happens when > I nap. It is what wakes me up. I researched the symptoms and was thinking > there was a correlation to LH and FSH based on the q 2 hour cycle. I also > considered a release of cortisol. Now I wonder if it is part and parcel of > the PA. Any thoughts? Is aldosterone released in intervals? If so, what's > the time frame?> >>> >>Finally, of the Stage IV symptoms, these are the ones > I've experienced: profound hypokalemia, polyuria, drug resistant HTN, > hand/feet/leg cramps, profound weakness, periodic paralysis (onset when I > stand but then it subsides in a couple of minutes), arrhythmias, mild > proteinuria, and alkaline urine.> >>> >>There is so much more I am probably > leaving out, but I am sure you will ask the questions that will free that > information. So, thank you for your time and consideration. I'm looking > forward to the journey.> >>> >>Barbara Tatro> >>> >>Medical > History> >>> >>1. Hypertension â?" DX 1989 - age 42 â?" Severe and resistant > since DX> >>2. Right Renal Artery Stenosis (70%) â?" 2009> >>3. Atrophic right > kidney> >>4. Adrenal adenoma â?" Left 2.2 x 2.5; Right 2.1 x 1.2 > >>Right > diagnosed 2-2000 (1.5); Left diagnosed 6-2009 and increased size of right > adenoma (described as adrenal nodules)> >>5. Hypokalemia (profound â?" 1st > incidence 1991, documented 2008-2011)> >>6. Mild hypercalcemia> >>7. > Hypomagnesemia> >>8. Micro hematuria (small)> >>9. Mild proteinuria> >>10. > Aortic calcification> >>11. Heat Intolerance> >>12. Back â?" T11-12 Central > disc extrusion, mild central canal stenosis; L1-2 bulging disc with > compression of thecal sac; L2-3 bulging disc compressing thecal sac; L3-4 > bulging disc, retroliathesis, central canal stenosis biforaminal stenosis; > L4-5 unroofed disc, spondyloliatheses, severe central canal and biforaminal > stenosis; L5-S1 extruded disc, left and right foraminal stenosis> >>13. Left > hip â?" joint space narrowing and arthritic changes, subchondral sclerosis > (rheumatoid v. osteoarthritis)> >>14. Left lateral leg neuropathy with > atrophy> >>15. Falling> >>16. Pneumonia â?" February, May, September > 2011> >>17. Bilateral otitis media â?" February, May, September 2011> >>18. > COPD> >>19. HPV> >>20. GI bleed â?" Diffuse gastritis â?" 2002 secondary to > NSAID therapy> >>21. Fuch's Corneal Dystrophy (left eye severe, right eye > mild to moderate)> >>22. Basal cell carcinoma left cheek > >>23. Adenomyosis > â?" D & C x 3 1970's> >>24. Fractures â?" right tibia, left thumb, spiral > fracture right 4th toe> >>25. Seasonal allergies> >>26. Chronic pain> >>27. > Depression, anxiety and panic attacks, `nervous breakdown' x3 â?" first at age > 19 â?" about every 10 years thereafter â?" last one 1985> >>28. Severe childhood > abuse and molestation> >>29. Smoker 1ppd x 40 years> >>> >>Surgeries> >>1. > Exploratory lap, choleycystectomy - 1977> >>2. Hysteroscopy â?" 1995> >>3. > Removal basal cell carcinoma left cheek â?" 2000> >>> >>Family History> >>1. > Father (deceased) â?" CHF, multiple MI, multiple CVA, Resistant HTN, Fuch's > Corneal Dystrophy, depression, HOH> >>2. Mother (deceased) â?" HTN, cervical > cancer, metastatic cancer > >>3. Sister (68) â?" Fuch's corneal dystrophy, > depression> >>4. Brother (66) â?" Bladder cancer, thyroid cancer, HTN, Type II > Diabetes, depression> >>5. Brother (60) â?" HTN, Depression, dysrhythmia> >>6. > Brother (46) - Dysrhythmia, depression> >>> >>Allergies> >>1. Serotonin â?" > Seizure, anaphylaxis, Serotonin Syndrome (ER x3)> >>2. Levaquin â?" Levaquin > Syndrome> >>3. Wellbutrin â?" Cardiac dysrhythmia> >>> >>Prevention> >>1. Flu > vaccine 11/2012> >>2. Pneumonia vaccine 11/2010> >>> >>Medications December > - 2011> >>> >>1. Lisinopril-Hctz 20/12.5 mg BID> >>2. Verapamil 120mg > BID> >>3. Labetalol 200mg BID > >>4. Pravastatin 20mg Q night> >>5. Doxepin > 75mg QD> >>6. ASA 81mg BID> >>7. Potassium 20 mEq BID> >>8. Doxepin 75 mg > QD> >>9. Ibuprofen 800mg BID> >>10. Zyrtec 10 mg QD> >>11. Glucosam/Chon > 1500/1200mg QD> >>12. Vit B12 1000mcg QD> >>13. Vit C 500mg QD> >>14. > Magnesium 250mg BID> >>15. Multi-Vit 1 tab QD> >>16. Fish Oil 1000 mg > BID> >>17. Ventolin Inhale 1-2 puffs PRN> >>18. Naproxen 440mg > PRN> >>> >>> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 13, 2012 Report Share Posted January 13, 2012 If you eat such a small amount, then probably it's okay. I am a big eater, so 0.5 oz of something is not for me. Potatoes are good , contain a lot of K, almost no Na and fewer calories than bananas. Natalia From: Barb Tatro <rainbowdayz@...> hyperaldosteronism Sent: Friday, January 13, 2012 1:03 AM Subject: Re: History/Story  Should clarify. The cheese is Laughing Cow light Swiss. The smoked salmon is 0.5 oz once a day on flat (180mg/2) with the light Swiss. The tuna (180mg) every third day or so. I use no table salt, do not drink anything but water and 1 cup of coffee/day. I season with herbs and lemon only. The bulk of my diet is mostly raw fruits and veggies. No red meat, potatoes, or bread. I will take a closer look at DASH now that I have imbedded. I will make alterations accordingly. Thanks for your insight and input. Barb Re: History/Story What was done if anything about the renal artery? How was the 70% Dxed? Did anyone hear a bruit over that artery? Have you ever taken BCPs? Don't see any renin aldo numbers? How much salt do you eat? Anyone ever mention DASHing? On Jan 11, 2012, at 11:18 PM, amazingkeltic wrote: Dear Dr. Grim,I am a 64-year-old female. I am a retired surgical heart ICU CCRN. I returned to college at age 39, and obtained a BSN. I also student taught A & P and Micro labs for 12 years post-graduation at Indiana University NW. I relocated to Houston, TX in 2001. During my nursing tenure, I worked in community hospitals and for several prestigious institutions including Methodist Hospital, Texas Medical Center, Houston, for and with DeBakey. I also worked for Hazim Safi's AAA unit at Memorial Hermann while in Houston. I have presented at several critical care consortiums and served as clinical educator at many of the facilities where I worked. So… looking back on this medical journey confounds me. I, of all people, should have done the research and found the answer. I attribute part of this phenomenon to the lack of computer skills. I bought my first computer in 2000. I wasn't what I would consider `computer literate' for a few more years. By this time, I was easily 15 years into my PA odyssey and convinced by professionals I trusted that my right adenoma was just an `incidental' finding and quite common. I pride myself in my knowledge base and assessment skills, but I very clearly dropped the ball when it came to me.I do not hold contempt for the doctors who led me astray. If I couldn't see the writing on the wall, why should they. I will say this, in 20+ years of critical care nursing I never once cared for a patient with PA as a primary or secondary diagnosis and I rarely cared for a patient whose home medications included Spironolactone. Fewer still were prescribed Spiro during their hospitalization. The beginning of the end: I was diagnosed with HTN during a routine screening to begin my nursing clinicals (age 42). The person who diagnosed it was an itty bitty nun who was about 104. Poor thing could barely inflate the cuff. Her first reading: 170/104. I assumed the extended inflation time had something to do with it and asked that she repeat it. She did. No change. The doctor that followed confirmed the DX. Begin the litany of BP meds dispensed so conservatively, I am surprised I didn't stroke while waiting. Every change that was made required a waiting period and another visit. Finally, a few years in, I showed some progress. BPs were generally 140-150's/80-90's and that was on a good day. The doc took the standard approach: started with a diuretic then added a CCB, ACE, and finally a b-blocker. See attachment for current medications. The b-blocker was Labetalol. When this was added (due to the alpha blocking), I completely stopped have the adrenalin rushes I had for years – so the offender was nor-epi and not epi? But this created an anti-depressant dilemma: block it with one med, then hold it in the synapse with another… hmmmm… the old come here, go away therapy. Any suggestions because I am on both currently?From age 19 until my diagnosis and treatment for clinical depression in 1985, I had repeated episodes of depression, anxiety attacks, panic attacks, even agoraphobia. When I was finally diagnosed, I was put on Doxepin and have taken it intermittently since that time. My history includes severe child abuse and molestation. So what do I do after I escaped? I, in essence, married my father and the abuse and stress continued. I just kept throwing more logs on the fire. I therefore attributed much of what I was experiencing to my history. I assumed my resistant pressures were anxiety-driven. During this time, I could feel the release of adrenalin. It hit my chest like 360joules. Then the panic and anxiety would ensue. After reading The Evolution, I see that psycho-social stress can produce adenomas. Huge ah-ha moment for this critical care RN. During this time, I suggested a possible pheochromocytoma diagnosis. With the uncontrollable HTN and added microhematuria and mild proteinuria I was beginning to have real concerns. Docs weren't buying that. Too rare. About as rare as PA. But I kept pushing so they started chasing a Lupus diagnosis. The ANA was negative and I was pronounced well, except for the psych issues <sigh>.After graduation (1992), I went to work in a community hospital med/surg ICU. At the same time, we moved and began building the `dream house' we could now afford. My four children were struggling to assimilate into a new environment and school. My oldest daughter was living with us with her baby while her husband served in Desert Storm. All four burners were full up and it wasn't long before I began floundering. One night I went to bed. It felt like me HR was about 200 and I could feel the PVCs. Each one made a pronounce thud in my chest followed by a momentary brain haze. It got so intense I finally asked my husband to take me to the ER. My potassium was 2.7. Their treatment of cure was 20mEq of effervescent potassium po and serial labs. I was released when my K+ hit 3.3. I was pronounced well and they sent me on my way.I scheduled an appointment with my doctor who was still not connecting the dots. He did add 20mEq of K+ daily to my meds. Things stayed pretty much the same. On anti-depressants, then off, uncontrolled HTN, micro hematuria, mild proteinuria, panic, anxiety off and on, same stuff that everyone now considered my normal.We built the house, kids were leaving one-by-one and the marriage had run its course. Divorce was inevitable. During this period, I developed `severe' right flank pain. It felt like if I could stick my finger inside my body up to my hand at the level of my inferior rib, I could touch where the pain was located. Now I get it. My doctor gave me some Vicodin which helped but I was miserable, couldn't find a comfortable position and it went on for 2 months. At that time he ordered a CT of my chest. God only knows why. The right adrenal adenoma (or nodule as it was described) was uncovered. Still not connecting the dots, him or me. That year I divorced and relocated to Houston. I was happier and felt healthier. I was even able to wean down my anti-hypertensives. This is when the issues with my back began and the introduction of daily NSAIDs. It is now a concern for me because I know there is an issue with combining NSAIDs and Spiro. Your thoughts?More life changes. I moved back to Chicago October 2004 and decided to give my failed marriage a second chance. It was less stressful than it had been, but still acceptable. Soon, I started having a lot of PVCs again. I was at work one night and decided to run a strip to see if these were PACs of PVCs. They were PVCs (bigeminy, trigeminy, and random). I had a nurse friend draw some blood and we sent it to lab. My potassium was 2.8. I called the pharmacy and they sent me 100 mEq of K+. It suppressed the PVCs for a few days but they returned. Again, I ran a strip, drew blood, K+ was 3.0. Sent for a supplement and went to the clinic. The doctor I had always seen left the Clinic, so I no longer had a doctor. An Immediate Care physician saw me. He ordered a 24-hr Holter and labs. The PVCs were ridiculously high. I know. I could feel every one. But nothing was done. No follow-up, consultations, referrals, or treatment.Things were deteriorating rapidly with the current living situation, so I moved out. I began having severe lower leg and feet cramps in 2008. I also was having frequent lower leg fasciculations, particularly when I'd lay down. I started taking B12 for the cramping which helped quite a bit. In January 2009 I moved to polis, MD to take a job at s Hopkins. A death in the family brought me home again in October 2009. I retired and it's been downhill ever since. Being uninsured until July 2012 (Medicare), I was seeing a NP at a local doc-in-a-box to get my prescriptions. I started having days filled with PVCs and depression. I was started back on Doxepin. Labs showed my potassium to be in the 3.0 to 3.2 range, a level that makes me symptomatic. Knowing the cause, I finally just started treating it myself, usually 80-120mEq over a day and a half and I would be okay for a couple of weeks. It was during this time that it registered how often I was urinating. It was so much that I finally bought a meter to check my BS. It was and is normal as is my A1C.I needed a higher level of care so I started seeing the PA at the doc-in-a-box thinking she would be consulting with the in-house doctor regarding my care. After the initial appointment, I was told they would no longer prescribe the Doxepin. The doctor thought I was taking it for sleep or selling it, not sure which. I also needed medication refills. The potassium called in was ½ my normal dose. I freaked because I was almost out and having PVCs again. So I gathered my history `evidence' and took it to the PA. She refused to prescribe the correct amount after I told her I was self-medicating and why with the proof in hand. After an embarrassing tete tete occurring in front of staff and a waiting room full of patients, I stormed out. I asked a friend pull a few strings (doctors won't see you if you're a self-pay I've discovered) and I got in to see a family practice doc in September 2011. Rather than have a staff member record my history incorrectly, I put it in H & P format and handed it to the doctor. While preparing the document, I decided to do some research on the causes of chronic low potassium other than the obvious (thiazide diuretic, albuterol inhaler, and recent rounds of prednisone for pneumonia). Imagine my surprise when Conn's popped up and I finally connected the dots. I am THE POSTER CHILD for Stage IV Conn's. When I had my appointment with the family practice doc, I said, "The bilateral adrenal adenomas are probably functional and it is highly likely that I have Conn's Syndrome". I told him about the low potassium, my symptoms, and how I had been treating it. Much to my surprise and without labs to back up my claim, he prescribed K+ supplements equal to my bi-tri-weekly fix. However, no PA blood or urine labs were ordered and his primary concern was the right renal artery stenosis. The way I viewed that: if my aorta showed calcification in 2000, it is highly likely that the renal artery is also calcified. I thought that was probable because I have been mildly hypercalcemic for years. That I attributed to higher blood calcium levels secondary to CCB therapy. Now I am not so sure.I do have a question: In your Evolution article you state that one of the symptoms of the 34-year-old female was a positive Chevostek and Trousseau. Aren't those tests reflective of low blood calcium? Also, my lab abnormalities are often part of the earth metal/alkaline earth metal periodic family. Is there a correlation other than the valence numbers?Also, a few days a month about an hour after I take my meds, I start feeling light-headed and strange. I know now that the feeling is related to bradycardia and hypotension (HR 50's, BP 80's/30-40's). As the half-life decreases the circulating levels, my HR and BP began looking like my baseline (HR 70's, BP 140-150/80-90). When I feel that way, my radial pulse is almost not palpable. Laying down, of course, helps. So, now I am thinking that, on those days, my aldosterone is suppressed. Am I right?Another thing: Around 2003-4 or so, we started using Nesiritide (atrial natriuretic – ANH stimulator) instead of Dobutrex and Primacor for our CHFers. In the Evolution article, you say that increased vascular pressures promotes natriuresis. So, it follows that these patients have decompensated and no longer respond to the body's compensatory mechanism, correct? Also, does this have something to do with the push for ACE inhibitors as the lead medication in treating HTN?One more question: I am post-menopausal but did have night sweats before menopause that I attributed to hormone levels. I still have night sweats but these are different. I wake up about every two hours. At first I feel almost afraid, my heart starts racing, then I feel completely strange, then I get really hot. The onset of another symptom ends the prior symptom. I've timed it from the fear feeling to the end. It lasts about 4-5 minutes. Then everything returns to normal. This happens most nights sometimes every two hours all night It even happens when I nap. It is what wakes me up. I researched the symptoms and was thinking there was a correlation to LH and FSH based on the q 2 hour cycle. I also considered a release of cortisol. Now I wonder if it is part and parcel of the PA. Any thoughts? Is aldosterone released in intervals? If so, what's the time frame?Finally, of the Stage IV symptoms, these are the ones I've experienced: profound hypokalemia, polyuria, drug resistant HTN, hand/feet/leg cramps, profound weakness, periodic paralysis (onset when I stand but then it subsides in a couple of minutes), arrhythmias, mild proteinuria, and alkaline urine.There is so much more I am probably leaving out, but I am sure you will ask the questions that will free that information. So, thank you for your time and consideration. I'm looking forward to the journey.Barbara TatroMedical History1. Hypertension – DX 1989 - age 42 – Severe and resistant since DX2. Right Renal Artery Stenosis (70%) – 20093. Atrophic right kidney4. Adrenal adenoma – Left 2.2 x 2.5; Right 2.1 x 1.2 Right diagnosed 2-2000 (1.5); Left diagnosed 6-2009 and increased size of right adenoma (described as adrenal nodules)5. Hypokalemia (profound – 1st incidence 1991, documented 2008-2011)6. Mild hypercalcemia7. Hypomagnesemia8. Micro hematuria (small)9. Mild proteinuria10. Aortic calcification11. Heat Intolerance12. Back – T11-12 Central disc extrusion, mild central canal stenosis; L1-2 bulging disc with compression of thecal sac; L2-3 bulging disc compressing thecal sac; L3-4 bulging disc, retroliathesis, central canal stenosis biforaminal stenosis; L4-5 unroofed disc, spondyloliatheses, severe central canal and biforaminal stenosis; L5-S1 extruded disc, left and right foraminal stenosis13. Left hip – joint space narrowing and arthritic changes, subchondral sclerosis (rheumatoid v. osteoarthritis)14. Left lateral leg neuropathy with atrophy15. Falling16. Pneumonia – February, May, September 201117. Bilateral otitis media – February, May, September 201118. COPD19. HPV20. GI bleed – Diffuse gastritis – 2002 secondary to NSAID therapy21. Fuch's Corneal Dystrophy (left eye severe, right eye mild to moderate)22. Basal cell carcinoma left cheek 23. Adenomyosis – D & C x 3 1970's24. Fractures – right tibia, left thumb, spiral fracture right 4th toe25. Seasonal allergies26. Chronic pain27. Depression, anxiety and panic attacks, `nervous breakdown' x3 – first at age 19 – about every 10 years thereafter – last one 198528. Severe childhood abuse and molestation29. Smoker 1ppd x 40 yearsSurgeries1. Exploratory lap, choleycystectomy - 19772. Hysteroscopy – 19953. Removal basal cell carcinoma left cheek – 2000Family History1. Father (deceased) – CHF, multiple MI, multiple CVA, Resistant HTN, Fuch's Corneal Dystrophy, depression, HOH2. Mother (deceased) – HTN, cervical cancer, metastatic cancer 3. Sister (68) – Fuch's corneal dystrophy, depression4. Brother (66) – Bladder cancer, thyroid cancer, HTN, Type II Diabetes, depression5. Brother (60) – HTN, Depression, dysrhythmia6. Brother (46) - Dysrhythmia, depressionAllergies1. Serotonin – Seizure, anaphylaxis, Serotonin Syndrome (ER x3)2. Levaquin – Levaquin Syndrome3. Wellbutrin – Cardiac dysrhythmiaPrevention1. Flu vaccine 11/20122. Pneumonia vaccine 11/2010Medications December - 20111. Lisinopril-Hctz 20/12.5 mg BID2. Verapamil 120mg BID3. Labetalol 200mg BID 4. Pravastatin 20mg Q night5. Doxepin 75mg QD6. ASA 81mg BID7. Potassium 20 mEq BID8. Doxepin 75 mg QD9. Ibuprofen 800mg BID10. Zyrtec 10 mg QD11. Glucosam/Chon 1500/1200mg QD12. Vit B12 1000mcg QD13. Vit C 500mg QD14. Magnesium 250mg BID15. Multi-Vit 1 tab QD16. Fish Oil 1000 mg BID17. Ventolin Inhale 1-2 puffs PRN18. Naproxen 440mg PRN Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 13, 2012 Report Share Posted January 13, 2012 we can eat plenty of cheese on DASH, but if your going to eat it with breads, canned or packaged meats then your going over. I eat plenty of cheese, but i keep my day at or below 1400 of sodium a day. Its not a starvation diet. If BP is your goal than 1500 seems to get it done. If your about weight loss than its calories not just salt and the best way is still to burn off more than you take in. ANYTHING that gets too extreme never works. ever. Dear Dr. Grim,I am a 64-year-old female. I am a retired surgical heart ICU CCRN. I returned to college at age 39, and obtained a BSN. I also student taught A & P and Micro labs for 12 years post-graduation at Indiana University NW. I relocated to Houston, TX in 2001. During my nursing tenure, I worked in community hospitals and for several prestigious institutions including Methodist Hospital, Texas Medical Center, Houston, for and with DeBakey. I also worked for Hazim Safi's AAA unit at Memorial Hermann while in Houston. I have presented at several critical care consortiums and served as clinical educator at many of the facilities where I worked. So… looking back on this medical journey confounds me. I, of all people, should have done the research and found the answer. I attribute part of this phenomenon to the lack of computer skills. I bought my first computer in 2000. I wasn't what I would consider `computer literate' for a few more years. By this time, I was easily 15 years into my PA odyssey and convinced by professionals I trusted that my right adenoma was just an `incidental' finding and quite common. I pride myself in my knowledge base and assessment skills, but I very clearly dropped the ball when it came to me.I do not hold contempt for the doctors who led me astray. If I couldn't see the writing on the wall, why should they. I will say this, in 20+ years of critical care nursing I never once cared for a patient with PA as a primary or secondary diagnosis and I rarely cared for a patient whose home medications included Spironolactone. Fewer still were prescribed Spiro during their hospitalization. The beginning of the end: I was diagnosed with HTN during a routine screening to begin my nursing clinicals (age 42). The person who diagnosed it was an itty bitty nun who was about 104. Poor thing could barely inflate the cuff. Her first reading: 170/104. I assumed the extended inflation time had something to do with it and asked that she repeat it. She did. No change. The doctor that followed confirmed the DX. Begin the litany of BP meds dispensed so conservatively, I am surprised I didn't stroke while waiting. Every change that was made required a waiting period and another visit. Finally, a few years in, I showed some progress. BPs were generally 140-150's/80-90's and that was on a good day. The doc took the standard approach: started with a diuretic then added a CCB, ACE, and finally a b-blocker. See attachment for current medications. The b-blocker was Labetalol. When this was added (due to the alpha blocking), I completely stopped have the adrenalin rushes I had for years – so the offender was nor-epi and not epi? But this created an anti-depressant dilemma: block it with one med, then hold it in the synapse with another… hmmmm… the old come here, go away therapy. Any suggestions because I am on both currently?From age 19 until my diagnosis and treatment for clinical depression in 1985, I had repeated episodes of depression, anxiety attacks, panic attacks, even agoraphobia. When I was finally diagnosed, I was put on Doxepin and have taken it intermittently since that time. My history includes severe child abuse and molestation. So what do I do after I escaped? I, in essence, married my father and the abuse and stress continued. I just kept throwing more logs on the fire. I therefore attributed much of what I was experiencing to my history. I assumed my resistant pressures were anxiety-driven. During this time, I could feel the release of adrenalin. It hit my chest like 360joules. Then the panic and anxiety would ensue. After reading The Evolution, I see that psycho-social stress can produce adenomas. Huge ah-ha moment for this critical care RN. During this time, I suggested a possible pheochromocytoma diagnosis. With the uncontrollable HTN and added microhematuria and mild proteinuria I was beginning to have real concerns. Docs weren't buying that. Too rare. About as rare as PA. But I kept pushing so they started chasing a Lupus diagnosis. The ANA was negative and I was pronounced well, except for the psych issues <sigh>.After graduation (1992), I went to work in a community hospital med/surg ICU. At the same time, we moved and began building the `dream house' we could now afford. My four children were struggling to assimilate into a new environment and school. My oldest daughter was living with us with her baby while her husband served in Desert Storm. All four burners were full up and it wasn't long before I began floundering. One night I went to bed. It felt like me HR was about 200 and I could feel the PVCs. Each one made a pronounce thud in my chest followed by a momentary brain haze. It got so intense I finally asked my husband to take me to the ER. My potassium was 2.7. Their treatment of cure was 20mEq of effervescent potassium po and serial labs. I was released when my K+ hit 3.3. I was pronounced well and they sent me on my way.I scheduled an appointment with my doctor who was still not connecting the dots. He did add 20mEq of K+ daily to my meds. Things stayed pretty much the same. On anti-depressants, then off, uncontrolled HTN, micro hematuria, mild proteinuria, panic, anxiety off and on, same stuff that everyone now considered my normal.We built the house, kids were leaving one-by-one and the marriage had run its course. Divorce was inevitable. During this period, I developed `severe' right flank pain. It felt like if I could stick my finger inside my body up to my hand at the level of my inferior rib, I could touch where the pain was located. Now I get it. My doctor gave me some Vicodin which helped but I was miserable, couldn't find a comfortable position and it went on for 2 months. At that time he ordered a CT of my chest. God only knows why. The right adrenal adenoma (or nodule as it was described) was uncovered. Still not connecting the dots, him or me. That year I divorced and relocated to Houston. I was happier and felt healthier. I was even able to wean down my anti-hypertensives. This is when the issues with my back began and the introduction of daily NSAIDs. It is now a concern for me because I know there is an issue with combining NSAIDs and Spiro. Your thoughts?More life changes. I moved back to Chicago October 2004 and decided to give my failed marriage a second chance. It was less stressful than it had been, but still acceptable. Soon, I started having a lot of PVCs again. I was at work one night and decided to run a strip to see if these were PACs of PVCs. They were PVCs (bigeminy, trigeminy, and random). I had a nurse friend draw some blood and we sent it to lab. My potassium was 2.8. I called the pharmacy and they sent me 100 mEq of K+. It suppressed the PVCs for a few days but they returned. Again, I ran a strip, drew blood, K+ was 3.0. Sent for a supplement and went to the clinic. The doctor I had always seen left the Clinic, so I no longer had a doctor. An Immediate Care physician saw me. He ordered a 24-hr Holter and labs. The PVCs were ridiculously high. I know. I could feel every one. But nothing was done. No follow-up, consultations, referrals, or treatment.Things were deteriorating rapidly with the current living situation, so I moved out. I began having severe lower leg and feet cramps in 2008. I also was having frequent lower leg fasciculations, particularly when I'd lay down. I started taking B12 for the cramping which helped quite a bit. In January 2009 I moved to polis, MD to take a job at s Hopkins. A death in the family brought me home again in October 2009. I retired and it's been downhill ever since. Being uninsured until July 2012 (Medicare), I was seeing a NP at a local doc-in-a-box to get my prescriptions. I started having days filled with PVCs and depression. I was started back on Doxepin. Labs showed my potassium to be in the 3.0 to 3.2 range, a level that makes me symptomatic. Knowing the cause, I finally just started treating it myself, usually 80-120mEq over a day and a half and I would be okay for a couple of weeks. It was during this time that it registered how often I was urinating. It was so much that I finally bought a meter to check my BS. It was and is normal as is my A1C.I needed a higher level of care so I started seeing the PA at the doc-in-a-box thinking she would be consulting with the in-house doctor regarding my care. After the initial appointment, I was told they would no longer prescribe the Doxepin. The doctor thought I was taking it for sleep or selling it, not sure which. I also needed medication refills. The potassium called in was ½ my normal dose. I freaked because I was almost out and having PVCs again. So I gathered my history `evidence' and took it to the PA. She refused to prescribe the correct amount after I told her I was self-medicating and why with the proof in hand. After an embarrassing tete tete occurring in front of staff and a waiting room full of patients, I stormed out. I asked a friend pull a few strings (doctors won't see you if you're a self-pay I've discovered) and I got in to see a family practice doc in September 2011. Rather than have a staff member record my history incorrectly, I put it in H & P format and handed it to the doctor. While preparing the document, I decided to do some research on the causes of chronic low potassium other than the obvious (thiazide diuretic, albuterol inhaler, and recent rounds of prednisone for pneumonia). Imagine my surprise when Conn's popped up and I finally connected the dots. I am THE POSTER CHILD for Stage IV Conn's. When I had my appointment with the family practice doc, I said, "The bilateral adrenal adenomas are probably functional and it is highly likely that I have Conn's Syndrome". I told him about the low potassium, my symptoms, and how I had been treating it. Much to my surprise and without labs to back up my claim, he prescribed K+ supplements equal to my bi-tri-weekly fix. However, no PA blood or urine labs were ordered and his primary concern was the right renal artery stenosis. The way I viewed that: if my aorta showed calcification in 2000, it is highly likely that the renal artery is also calcified. I thought that was probable because I have been mildly hypercalcemic for years. That I attributed to higher blood calcium levels secondary to CCB therapy. Now I am not so sure.I do have a question: In your Evolution article you state that one of the symptoms of the 34-year-old female was a positive Chevostek and Trousseau. Aren't those tests reflective of low blood calcium? Also, my lab abnormalities are often part of the earth metal/alkaline earth metal periodic family. Is there a correlation other than the valence numbers?Also, a few days a month about an hour after I take my meds, I start feeling light-headed and strange. I know now that the feeling is related to bradycardia and hypotension (HR 50's, BP 80's/30-40's). As the half-life decreases the circulating levels, my HR and BP began looking like my baseline (HR 70's, BP 140-150/80-90). When I feel that way, my radial pulse is almost not palpable. Laying down, of course, helps. So, now I am thinking that, on those days, my aldosterone is suppressed. Am I right?Another thing: Around 2003-4 or so, we started using Nesiritide (atrial natriuretic – ANH stimulator) instead of Dobutrex and Primacor for our CHFers. In the Evolution article, you say that increased vascular pressures promotes natriuresis. So, it follows that these patients have decompensated and no longer respond to the body's compensatory mechanism, correct? Also, does this have something to do with the push for ACE inhibitors as the lead medication in treating HTN?One more question: I am post-menopausal but did have night sweats before menopause that I attributed to hormone levels. I still have night sweats but these are different. I wake up about every two hours. At first I feel almost afraid, my heart starts racing, then I feel completely strange, then I get really hot. The onset of another symptom ends the prior symptom. I've timed it from the fear feeling to the end. It lasts about 4-5 minutes. Then everything returns to normal. This happens most nights sometimes every two hours all night It even happens when I nap. It is what wakes me up. I researched the symptoms and was thinking there was a correlation to LH and FSH based on the q 2 hour cycle. I also considered a release of cortisol. Now I wonder if it is part and parcel of the PA. Any thoughts? Is aldosterone released in intervals? If so, what's the time frame?Finally, of the Stage IV symptoms, these are the ones I've experienced: profound hypokalemia, polyuria, drug resistant HTN, hand/feet/leg cramps, profound weakness, periodic paralysis (onset when I stand but then it subsides in a couple of minutes), arrhythmias, mild proteinuria, and alkaline urine.There is so much more I am probably leaving out, but I am sure you will ask the questions that will free that information. So, thank you for your time and consideration. I'm looking forward to the journey.Barbara TatroMedical History1. Hypertension – DX 1989 - age 42 – Severe and resistant since DX2. Right Renal Artery Stenosis (70%) – 20093. Atrophic right kidney4. Adrenal adenoma – Left 2.2 x 2.5; Right 2.1 x 1.2 Right diagnosed 2-2000 (1.5); Left diagnosed 6-2009 and increased size of right adenoma (described as adrenal nodules)5. Hypokalemia (profound – 1st incidence 1991, documented 2008-2011)6. Mild hypercalcemia7. Hypomagnesemia8. Micro hematuria (small)9. Mild proteinuria10. Aortic calcification11. Heat Intolerance12. Back – T11-12 Central disc extrusion, mild central canal stenosis; L1-2 bulging disc with compression of thecal sac; L2-3 bulging disc compressing thecal sac; L3-4 bulging disc, retroliathesis, central canal stenosis biforaminal stenosis; L4-5 unroofed disc, spondyloliatheses, severe central canal and biforaminal stenosis; L5-S1 extruded disc, left and right foraminal stenosis13. Left hip – joint space narrowing and arthritic changes, subchondral sclerosis (rheumatoid v. osteoarthritis)14. Left lateral leg neuropathy with atrophy15. Falling16. Pneumonia – February, May, September 201117. Bilateral otitis media – February, May, September 201118. COPD19. HPV20. GI bleed – Diffuse gastritis – 2002 secondary to NSAID therapy21. Fuch's Corneal Dystrophy (left eye severe, right eye mild to moderate)22. Basal cell carcinoma left cheek 23. Adenomyosis – D & C x 3 1970's24. Fractures – right tibia, left thumb, spiral fracture right 4th toe25. Seasonal allergies26. Chronic pain27. Depression, anxiety and panic attacks, `nervous breakdown' x3 – first at age 19 – about every 10 years thereafter – last one 198528. Severe childhood abuse and molestation29. Smoker 1ppd x 40 yearsSurgeries1. Exploratory lap, choleycystectomy - 19772. Hysteroscopy – 19953. Removal basal cell carcinoma left cheek – 2000Family History1. Father (deceased) – CHF, multiple MI, multiple CVA, Resistant HTN, Fuch's Corneal Dystrophy, depression, HOH2. Mother (deceased) – HTN, cervical cancer, metastatic cancer 3. Sister (68) – Fuch's corneal dystrophy, depression4. Brother (66) – Bladder cancer, thyroid cancer, HTN, Type II Diabetes, depression5. Brother (60) – HTN, Depression, dysrhythmia6. Brother (46) - Dysrhythmia, depressionAllergies1. Serotonin – Seizure, anaphylaxis, Serotonin Syndrome (ER x3)2. Levaquin – Levaquin Syndrome3. Wellbutrin – Cardiac dysrhythmiaPrevention1. Flu vaccine 11/20122. Pneumonia vaccine 11/2010Medications December - 20111. Lisinopril-Hctz 20/12.5 mg BID2. Verapamil 120mg BID3. Labetalol 200mg BID 4. Pravastatin 20mg Q night5. Doxepin 75mg QD6. ASA 81mg BID7. Potassium 20 mEq BID8. Doxepin 75 mg QD9. Ibuprofen 800mg BID10. Zyrtec 10 mg QD11. Glucosam/Chon 1500/1200mg QD12. Vit B12 1000mcg QD13. Vit C 500mg QD14. Magnesium 250mg BID15. Multi-Vit 1 tab QD16. Fish Oil 1000 mg BID17. Ventolin Inhale 1-2 puffs PRN18. Naproxen 440mg PRN Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 14, 2012 Report Share Posted January 14, 2012 My husband and I have been on the DASH diet since 2007 after his MI. We were given the literature at some point and it worked for him; he's still alive. For me, I have never tolerated salt, so it wasn't that big of a change; raised vegetarian, now more vegan, but I mostly had to make sure my carbs and protien were matched and that helped me lose the weight I needed to lose. Never had issues with BP until a few months ago, haven't changed the diet or exercise, just got high bp out of the blue and low potassium out of the blue. > >> > >> > >>>Dear Dr. Grim, > >>> > >>>I am a 64-year-old female. I am a retired > surgical heart ICU CCRN. I returned to college at age 39, and obtained a > BSN. I also student taught A & P and Micro labs for 12 years > post-graduation at Indiana University NW. I relocated to Houston, TX in > 2001. During my nursing tenure, I worked in community hospitals and for > several prestigious institutions including Methodist Hospital, Texas > Medical Center, Houston, for and with DeBakey. I also worked for > Hazim Safi's AAA unit at Memorial Hermann while in Houston. I have > presented at several critical care consortiums and served as clinical > educator at many of the facilities where I worked. > >>> > >>>So… looking > back on this medical journey confounds me. I, of all people, should have > done the research and found the answer. I attribute part of this > phenomenon to the lack of computer skills. I bought my first computer in > 2000. I wasn't what I would consider `computer literate' for a few more > years. By this time, I was easily 15 years into my PA odyssey and > convinced by professionals I trusted that my right adenoma was just an > `incidental' finding and quite common. I pride myself in my knowledge base > and assessment skills, but I very clearly dropped the ball when it came to > me. > >>> > >>>I do not hold contempt for the doctors who led me astray. If I > couldn't see the writing on the wall, why should they. I will say this, in > 20+ years of critical care nursing I never once cared for a patient with > PA as a primary or secondary diagnosis and I rarely cared for a patient > whose home medications included Spironolactone. Fewer still were > prescribed Spiro during their hospitalization. > >>> > >>>The beginning of > the end: I was diagnosed with HTN during a routine screening to begin my > nursing clinicals (age 42). The person who diagnosed it was an itty bitty > nun who was about 104. Poor thing could barely inflate the cuff. Her first > reading: 170/104. I assumed the extended inflation time had something to > do with it and asked that she repeat it. She did. No change. The doctor > that followed confirmed the DX. Begin the litany of BP meds dispensed so > conservatively, I am surprised I didn't stroke while waiting. Every change > that was made required a waiting period and another visit. Finally, a few > years in, I showed some progress. BPs were generally 140-150's/80-90's and > that was on a good day. The doc took the standard approach: started with a > diuretic then added a CCB, ACE, and finally a b-blocker. See attachment > for current medications. The b-blocker was Labetalol. When this was added > (due to the alpha blocking), I completely stopped have the adrenalin > rushes I had for years †" so the offender was nor-epi and not epi? But this > created an anti-depressant dilemma: block it with one med, then hold it in > the synapse with another… hmmmm… the old come here, go away therapy. Any > suggestions because I am on both currently? > >>> > >>>From age 19 until my > diagnosis and treatment for clinical depression in 1985, I had repeated > episodes of depression, anxiety attacks, panic attacks, even agoraphobia. > When I was finally diagnosed, I was put on Doxepin and have taken it > intermittently since that time. My history includes severe child abuse and > molestation. So what do I do after I escaped? I, in essence, married my > father and the abuse and stress continued. I just kept throwing more logs > on the fire. I therefore attributed much of what I was experiencing to my > history. I assumed my resistant pressures were anxiety-driven. During this > time, I could feel the release of adrenalin. It hit my chest like > 360joules. Then the panic and anxiety would ensue. After reading The > Evolution, I see that psycho-social stress can produce adenomas. Huge > ah-ha moment for this critical care RN. > >>> > >>>During this time, I > suggested a possible pheochromocytoma diagnosis. With the uncontrollable > HTN and added microhematuria and mild proteinuria I was beginning to have > real concerns. Docs weren't buying that. Too rare. About as rare as PA. > But I kept pushing so they started chasing a Lupus diagnosis. The ANA was > negative and I was pronounced well, except for the psych issues > <sigh>. > >>> > >>>After graduation (1992), I went to work in a > community hospital med/surg ICU. At the same time, we moved and began > building the `dream house' we could now afford. My four children were > struggling to assimilate into a new environment and school. My oldest > daughter was living with us with her baby while her husband served in > Desert Storm. All four burners were full up and it wasn't long before I > began floundering. One night I went to bed. It felt like me HR was about > 200 and I could feel the PVCs. Each one made a pronounce thud in my chest > followed by a momentary brain haze. It got so intense I finally asked my > husband to take me to the ER. My potassium was 2.7. Their treatment of > cure was 20mEq of effervescent potassium po and serial labs. I was > released when my K+ hit 3.3. I was pronounced well and they sent me on my > way. > >>> > >>>I scheduled an appointment with my doctor who was still not > connecting the dots. He did add 20mEq of K+ daily to my meds. Things > stayed pretty much the same. On anti-depressants, then off, uncontrolled > HTN, micro hematuria, mild proteinuria, panic, anxiety off and on, same > stuff that everyone now considered my normal. > >>> > >>>We built the house, > kids were leaving one-by-one and the marriage had run its course. Divorce > was inevitable. During this period, I developed `severe' right flank pain. > It felt like if I could stick my finger inside my body up to my hand at > the level of my inferior rib, I could touch where the pain was located. > Now I get it. My doctor gave me some Vicodin which helped but I was > miserable, couldn't find a comfortable position and it went on for 2 > months. At that time he ordered a CT of my chest. God only knows why. The > right adrenal adenoma (or nodule as it was described) was uncovered. Still > not connecting the dots, him or me. > >>> > >>>That year I divorced and > relocated to Houston. I was happier and felt healthier. I was even able to > wean down my anti-hypertensives. This is when the issues with my back > began and the introduction of daily NSAIDs. It is now a concern for me > because I know there is an issue with combining NSAIDs and Spiro. Your > thoughts? > >>> > >>>More life changes. I moved back to Chicago October 2004 > and decided to give my failed marriage a second chance. It was less > stressful than it had been, but still acceptable. Soon, I started having a > lot of PVCs again. I was at work one night and decided to run a strip to > see if these were PACs of PVCs. They were PVCs (bigeminy, trigeminy, and > random). I had a nurse friend draw some blood and we sent it to lab. My > potassium was 2.8. I called the pharmacy and they sent me 100 mEq of K+. > It suppressed the PVCs for a few days but they returned. Again, I ran a > strip, drew blood, K+ was 3.0. Sent for a supplement and went to the > clinic. The doctor I had always seen left the Clinic, so I no longer had a > doctor. An Immediate Care physician saw me. He ordered a 24-hr Holter and > labs. The PVCs were ridiculously high. I know. I could feel every one. But > nothing was done. No follow-up, consultations, referrals, or > treatment. > >>> > >>>Things were deteriorating rapidly with the current > living situation, so I moved out. I began having severe lower leg and feet > cramps in 2008. I also was having frequent lower leg fasciculations, > particularly when I'd lay down. I started taking B12 for the cramping > which helped quite a bit. In January 2009 I moved to polis, MD to take > a job at s Hopkins. A death in the family brought me home again in > October 2009. I retired and it's been downhill ever since. > >>> > >>>Being > uninsured until July 2012 (Medicare), I was seeing a NP at a local > doc-in-a-box to get my prescriptions. I started having days filled with > PVCs and depression. I was started back on Doxepin. Labs showed my > potassium to be in the 3.0 to 3.2 range, a level that makes me > symptomatic. Knowing the cause, I finally just started treating it myself, > usually 80-120mEq over a day and a half and I would be okay for a couple > of weeks. It was during this time that it registered how often I was > urinating. It was so much that I finally bought a meter to check my BS. It > was and is normal as is my A1C. > >>> > >>>I needed a higher level of care so > I started seeing the PA at the doc-in-a-box thinking she would be > consulting with the in-house doctor regarding my care. After the initial > appointment, I was told they would no longer prescribe the Doxepin. The > doctor thought I was taking it for sleep or selling it, not sure which. I > also needed medication refills. The potassium called in was ½ my normal > dose. I freaked because I was almost out and having PVCs again. So I > gathered my history `evidence' and took it to the PA. She refused to > prescribe the correct amount after I told her I was self-medicating and > why with the proof in hand. After an embarrassing tete tete occurring in > front of staff and a waiting room full of patients, I stormed out. I asked > a friend pull a few strings (doctors won't see you if you're a self-pay > I've discovered) and I got in to see a family practice doc in September > 2011. > >>> > >>>Rather than have a staff member record my history > incorrectly, I put it in H & P format and handed it to the doctor. While > preparing the document, I decided to do some research on the causes of > chronic low potassium other than the obvious (thiazide diuretic, albuterol > inhaler, and recent rounds of prednisone for pneumonia). Imagine my > surprise when Conn's popped up and I finally connected the dots. I am THE > POSTER CHILD for Stage IV Conn's. > >>> > >>>When I had my appointment with > the family practice doc, I said, " The bilateral adrenal adenomas are > probably functional and it is highly likely that I have Conn's Syndrome " . > I told him about the low potassium, my symptoms, and how I had been > treating it. Much to my surprise and without labs to back up my claim, he > prescribed K+ supplements equal to my bi-tri-weekly fix. However, no PA > blood or urine labs were ordered and his primary concern was the right > renal artery stenosis. The way I viewed that: if my aorta showed > calcification in 2000, it is highly likely that the renal artery is also > calcified. I thought that was probable because I have been mildly > hypercalcemic for years. That I attributed to higher blood calcium levels > secondary to CCB therapy. Now I am not so sure. > >>> > >>>I do have a > question: In your Evolution article you state that one of the symptoms of > the 34-year-old female was a positive Chevostek and Trousseau. Aren't > those tests reflective of low blood calcium? Also, my lab abnormalities > are often part of the earth metal/alkaline earth metal periodic family. Is > there a correlation other than the valence numbers? > >>> > >>>Also, a few > days a month about an hour after I take my meds, I start feeling > light-headed and strange. I know now that the feeling is related to > bradycardia and hypotension (HR 50's, BP 80's/30-40's). As the half-life > decreases the circulating levels, my HR and BP began looking like my > baseline (HR 70's, BP 140-150/80-90). When I feel that way, my radial > pulse is almost not palpable. Laying down, of course, helps. So, now I am > thinking that, on those days, my aldosterone is suppressed. Am I > right? > >>> > >>>Another thing: Around 2003-4 or so, we started using > Nesiritide (atrial natriuretic †" ANH stimulator) instead of Dobutrex and > Primacor for our CHFers. In the Evolution article, you say that increased > vascular pressures promotes natriuresis. So, it follows that these > patients have decompensated and no longer respond to the body's > compensatory mechanism, correct? Also, does this have something to do with > the push for ACE inhibitors as the lead medication in treating > HTN? > >>> > >>>One more question: I am post-menopausal but did have night > sweats before menopause that I attributed to hormone levels. I still have > night sweats but these are different. I wake up about every two hours. At > first I feel almost afraid, my heart starts racing, then I feel completely > strange, then I get really hot. The onset of another symptom ends the > prior symptom. I've timed it from the fear feeling to the end. It lasts > about 4-5 minutes. Then everything returns to normal. This happens most > nights sometimes every two hours all night It even happens when I nap. It > is what wakes me up. I researched the symptoms and was thinking there was > a correlation to LH and FSH based on the q 2 hour cycle. I also considered > a release of cortisol. Now I wonder if it is part and parcel of the PA. > Any thoughts? Is aldosterone released in intervals? If so, what's the time > frame? > >>> > >>>Finally, of the Stage IV symptoms, these are the ones I've > experienced: profound hypokalemia, polyuria, drug resistant HTN, > hand/feet/leg cramps, profound weakness, periodic paralysis (onset when I > stand but then it subsides in a couple of minutes), arrhythmias, mild > proteinuria, and alkaline urine. > >>> > >>>There is so much more I am > probably leaving out, but I am sure you will ask the questions that will > free that information. So, thank you for your time and consideration. I'm > looking forward to the journey. > >>> > >>>Barbara Tatro > >>> > >>>Medical > History > >>> > >>>1. Hypertension †" DX 1989 - age 42 †" Severe and resistant > since DX > >>>2. Right Renal Artery Stenosis (70%) †" 2009 > >>>3. Atrophic > right kidney > >>>4. Adrenal adenoma †" Left 2.2 x 2.5; Right 2.1 x 1.2 > >>>Right diagnosed 2-2000 (1.5); Left diagnosed 6-2009 and increased size > of right adenoma (described as adrenal nodules) > >>>5. Hypokalemia > (profound †" 1st incidence 1991, documented 2008-2011) > >>>6. Mild > hypercalcemia > >>>7. Hypomagnesemia > >>>8. Micro hematuria (small) > >>>9. > Mild proteinuria > >>>10. Aortic calcification > >>>11. Heat > Intolerance > >>>12. Back †" T11-12 Central disc extrusion, mild central > canal stenosis; L1-2 bulging disc with compression of thecal sac; L2-3 > bulging disc compressing thecal sac; L3-4 bulging disc, retroliathesis, > central canal stenosis biforaminal stenosis; L4-5 unroofed disc, > spondyloliatheses, severe central canal and biforaminal stenosis; L5-S1 > extruded disc, left and right foraminal stenosis > >>>13. Left hip †" joint > space narrowing and arthritic changes, subchondral sclerosis (rheumatoid > v. osteoarthritis) > >>>14. Left lateral leg neuropathy with atrophy > >>>15. > Falling > >>>16. Pneumonia †" February, May, September 2011 > >>>17. Bilateral > otitis media †" February, May, September 2011 > >>>18. COPD > >>>19. HPV > >>>20. > GI bleed †" Diffuse gastritis †" 2002 secondary to NSAID therapy > >>>21. > Fuch's Corneal Dystrophy (left eye severe, right eye mild to > moderate) > >>>22. Basal cell carcinoma left cheek > >>>23. Adenomyosis †" > D & C x 3 1970's > >>>24. Fractures †" right tibia, left thumb, spiral > fracture right 4th toe > >>>25. Seasonal allergies > >>>26. Chronic > pain > >>>27. Depression, anxiety and panic attacks, `nervous breakdown' x3 > †" first at age 19 †" about every 10 years thereafter †" last one 1985 > >>>28. > Severe childhood abuse and molestation > >>>29. Smoker 1ppd x 40 > years > >>> > >>>Surgeries > >>>1. Exploratory lap, choleycystectomy - > 1977 > >>>2. Hysteroscopy †" 1995 > >>>3. Removal basal cell carcinoma left > cheek †" 2000 > >>> > >>>Family History > >>>1. Father (deceased) †" CHF, multiple > MI, multiple CVA, Resistant HTN, Fuch's Corneal Dystrophy, depression, > HOH > >>>2. Mother (deceased) †" HTN, cervical cancer, metastatic cancer > >>>3. Sister (68) †" Fuch's corneal dystrophy, depression > >>>4. Brother > (66) †" Bladder cancer, thyroid cancer, HTN, Type II Diabetes, > depression > >>>5. Brother (60) †" HTN, Depression, dysrhythmia > >>>6. Brother > (46) - Dysrhythmia, depression > >>> > >>>Allergies > >>>1. Serotonin †" Seizure, > anaphylaxis, Serotonin Syndrome (ER x3) > >>>2. Levaquin †" Levaquin > Syndrome > >>>3. Wellbutrin †" Cardiac dysrhythmia > >>> > >>>Prevention > >>>1. > Flu vaccine 11/2012 > >>>2. Pneumonia vaccine 11/2010 > >>> > >>>Medications > December - 2011 > >>> > >>>1. Lisinopril-Hctz 20/12.5 mg BID > >>>2. Verapamil > 120mg BID > >>>3. Labetalol 200mg BID > >>>4. Pravastatin 20mg Q night > >>>5. > Doxepin 75mg QD > >>>6. ASA 81mg BID > >>>7. Potassium 20 mEq BID > >>>8. > Doxepin 75 mg QD > >>>9. Ibuprofen 800mg BID > >>>10. Zyrtec 10 mg QD > >>>11. > Glucosam/Chon 1500/1200mg QD > >>>12. Vit B12 1000mcg QD > >>>13. Vit C 500mg > QD > >>>14. Magnesium 250mg BID > >>>15. Multi-Vit 1 tab QD > >>>16. Fish Oil > 1000 mg BID > >>>17. Ventolin Inhale 1-2 puffs PRN > >>>18. Naproxen 440mg > PRN > >>> > >>> > >> > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 14, 2012 Report Share Posted January 14, 2012 Are you sure you are DASHING. Only way to know for sure as to test urine. > > >> > > >> > > >>>Dear Dr. Grim, > > >>> > > >>>I am a 64-year-old female. I am a retired > > surgical heart ICU CCRN. I returned to college at age 39, and obtained a > > BSN. I also student taught A & P and Micro labs for 12 years > > post-graduation at Indiana University NW. I relocated to Houston, TX in > > 2001. During my nursing tenure, I worked in community hospitals and for > > several prestigious institutions including Methodist Hospital, Texas > > Medical Center, Houston, for and with DeBakey. I also worked for > > Hazim Safi's AAA unit at Memorial Hermann while in Houston. I have > > presented at several critical care consortiums and served as clinical > > educator at many of the facilities where I worked. > > >>> > > >>>So… looking > > back on this medical journey confounds me. I, of all people, should have > > done the research and found the answer. I attribute part of this > > phenomenon to the lack of computer skills. I bought my first computer in > > 2000. I wasn't what I would consider `computer literate' for a few more > > years. By this time, I was easily 15 years into my PA odyssey and > > convinced by professionals I trusted that my right adenoma was just an > > `incidental' finding and quite common. I pride myself in my knowledge base > > and assessment skills, but I very clearly dropped the ball when it came to > > me. > > >>> > > >>>I do not hold contempt for the doctors who led me astray. If I > > couldn't see the writing on the wall, why should they. I will say this, in > > 20+ years of critical care nursing I never once cared for a patient with > > PA as a primary or secondary diagnosis and I rarely cared for a patient > > whose home medications included Spironolactone. Fewer still were > > prescribed Spiro during their hospitalization. > > >>> > > >>>The beginning of > > the end: I was diagnosed with HTN during a routine screening to begin my > > nursing clinicals (age 42). The person who diagnosed it was an itty bitty > > nun who was about 104. Poor thing could barely inflate the cuff. Her first > > reading: 170/104. I assumed the extended inflation time had something to > > do with it and asked that she repeat it. She did. No change. The doctor > > that followed confirmed the DX. Begin the litany of BP meds dispensed so > > conservatively, I am surprised I didn't stroke while waiting. Every change > > that was made required a waiting period and another visit. Finally, a few > > years in, I showed some progress. BPs were generally 140-150's/80-90's and > > that was on a good day. The doc took the standard approach: started with a > > diuretic then added a CCB, ACE, and finally a b-blocker. See attachment > > for current medications. The b-blocker was Labetalol. When this was added > > (due to the alpha blocking), I completely stopped have the adrenalin > > rushes I had for years †" so the offender was nor-epi and not epi? But this > > created an anti-depressant dilemma: block it with one med, then hold it in > > the synapse with another… hmmmm… the old come here, go away therapy. Any > > suggestions because I am on both currently? > > >>> > > >>>From age 19 until my > > diagnosis and treatment for clinical depression in 1985, I had repeated > > episodes of depression, anxiety attacks, panic attacks, even agoraphobia. > > When I was finally diagnosed, I was put on Doxepin and have taken it > > intermittently since that time. My history includes severe child abuse and > > molestation. So what do I do after I escaped? I, in essence, married my > > father and the abuse and stress continued. I just kept throwing more logs > > on the fire. I therefore attributed much of what I was experiencing to my > > history. I assumed my resistant pressures were anxiety-driven. During this > > time, I could feel the release of adrenalin. It hit my chest like > > 360joules. Then the panic and anxiety would ensue. After reading The > > Evolution, I see that psycho-social stress can produce adenomas. Huge > > ah-ha moment for this critical care RN. > > >>> > > >>>During this time, I > > suggested a possible pheochromocytoma diagnosis. With the uncontrollable > > HTN and added microhematuria and mild proteinuria I was beginning to have > > real concerns. Docs weren't buying that. Too rare. About as rare as PA. > > But I kept pushing so they started chasing a Lupus diagnosis. The ANA was > > negative and I was pronounced well, except for the psych issues > > <sigh>. > > >>> > > >>>After graduation (1992), I went to work in a > > community hospital med/surg ICU. At the same time, we moved and began > > building the `dream house' we could now afford. My four children were > > struggling to assimilate into a new environment and school. My oldest > > daughter was living with us with her baby while her husband served in > > Desert Storm. All four burners were full up and it wasn't long before I > > began floundering. One night I went to bed. It felt like me HR was about > > 200 and I could feel the PVCs. Each one made a pronounce thud in my chest > > followed by a momentary brain haze. It got so intense I finally asked my > > husband to take me to the ER. My potassium was 2.7. Their treatment of > > cure was 20mEq of effervescent potassium po and serial labs. I was > > released when my K+ hit 3.3. I was pronounced well and they sent me on my > > way. > > >>> > > >>>I scheduled an appointment with my doctor who was still not > > connecting the dots. He did add 20mEq of K+ daily to my meds. Things > > stayed pretty much the same. On anti-depressants, then off, uncontrolled > > HTN, micro hematuria, mild proteinuria, panic, anxiety off and on, same > > stuff that everyone now considered my normal. > > >>> > > >>>We built the house, > > kids were leaving one-by-one and the marriage had run its course. Divorce > > was inevitable. During this period, I developed `severe' right flank pain. > > It felt like if I could stick my finger inside my body up to my hand at > > the level of my inferior rib, I could touch where the pain was located. > > Now I get it. My doctor gave me some Vicodin which helped but I was > > miserable, couldn't find a comfortable position and it went on for 2 > > months. At that time he ordered a CT of my chest. God only knows why. The > > right adrenal adenoma (or nodule as it was described) was uncovered. Still > > not connecting the dots, him or me. > > >>> > > >>>That year I divorced and > > relocated to Houston. I was happier and felt healthier. I was even able to > > wean down my anti-hypertensives. This is when the issues with my back > > began and the introduction of daily NSAIDs. It is now a concern for me > > because I know there is an issue with combining NSAIDs and Spiro. Your > > thoughts? > > >>> > > >>>More life changes. I moved back to Chicago October 2004 > > and decided to give my failed marriage a second chance. It was less > > stressful than it had been, but still acceptable. Soon, I started having a > > lot of PVCs again. I was at work one night and decided to run a strip to > > see if these were PACs of PVCs. They were PVCs (bigeminy, trigeminy, and > > random). I had a nurse friend draw some blood and we sent it to lab. My > > potassium was 2.8. I called the pharmacy and they sent me 100 mEq of K+. > > It suppressed the PVCs for a few days but they returned. Again, I ran a > > strip, drew blood, K+ was 3.0. Sent for a supplement and went to the > > clinic. The doctor I had always seen left the Clinic, so I no longer had a > > doctor. An Immediate Care physician saw me. He ordered a 24-hr Holter and > > labs. The PVCs were ridiculously high. I know. I could feel every one. But > > nothing was done. No follow-up, consultations, referrals, or > > treatment. > > >>> > > >>>Things were deteriorating rapidly with the current > > living situation, so I moved out. I began having severe lower leg and feet > > cramps in 2008. I also was having frequent lower leg fasciculations, > > particularly when I'd lay down. I started taking B12 for the cramping > > which helped quite a bit. In January 2009 I moved to polis, MD to take > > a job at s Hopkins. A death in the family brought me home again in > > October 2009. I retired and it's been downhill ever since. > > >>> > > >>>Being > > uninsured until July 2012 (Medicare), I was seeing a NP at a local > > doc-in-a-box to get my prescriptions. I started having days filled with > > PVCs and depression. I was started back on Doxepin. Labs showed my > > potassium to be in the 3.0 to 3.2 range, a level that makes me > > symptomatic. Knowing the cause, I finally just started treating it myself, > > usually 80-120mEq over a day and a half and I would be okay for a couple > > of weeks. It was during this time that it registered how often I was > > urinating. It was so much that I finally bought a meter to check my BS. It > > was and is normal as is my A1C. > > >>> > > >>>I needed a higher level of care so > > I started seeing the PA at the doc-in-a-box thinking she would be > > consulting with the in-house doctor regarding my care. After the initial > > appointment, I was told they would no longer prescribe the Doxepin. The > > doctor thought I was taking it for sleep or selling it, not sure which. I > > also needed medication refills. The potassium called in was ½ my normal > > dose. I freaked because I was almost out and having PVCs again. So I > > gathered my history `evidence' and took it to the PA. She refused to > > prescribe the correct amount after I told her I was self-medicating and > > why with the proof in hand. After an embarrassing tete tete occurring in > > front of staff and a waiting room full of patients, I stormed out. I asked > > a friend pull a few strings (doctors won't see you if you're a self-pay > > I've discovered) and I got in to see a family practice doc in September > > 2011. > > >>> > > >>>Rather than have a staff member record my history > > incorrectly, I put it in H & P format and handed it to the doctor. While > > preparing the document, I decided to do some research on the causes of > > chronic low potassium other than the obvious (thiazide diuretic, albuterol > > inhaler, and recent rounds of prednisone for pneumonia). Imagine my > > surprise when Conn's popped up and I finally connected the dots. I am THE > > POSTER CHILD for Stage IV Conn's. > > >>> > > >>>When I had my appointment with > > the family practice doc, I said, " The bilateral adrenal adenomas are > > probably functional and it is highly likely that I have Conn's Syndrome " . > > I told him about the low potassium, my symptoms, and how I had been > > treating it. Much to my surprise and without labs to back up my claim, he > > prescribed K+ supplements equal to my bi-tri-weekly fix. However, no PA > > blood or urine labs were ordered and his primary concern was the right > > renal artery stenosis. The way I viewed that: if my aorta showed > > calcification in 2000, it is highly likely that the renal artery is also > > calcified. I thought that was probable because I have been mildly > > hypercalcemic for years. That I attributed to higher blood calcium levels > > secondary to CCB therapy. Now I am not so sure. > > >>> > > >>>I do have a > > question: In your Evolution article you state that one of the symptoms of > > the 34-year-old female was a positive Chevostek and Trousseau. Aren't > > those tests reflective of low blood calcium? Also, my lab abnormalities > > are often part of the earth metal/alkaline earth metal periodic family. Is > > there a correlation other than the valence numbers? > > >>> > > >>>Also, a few > > days a month about an hour after I take my meds, I start feeling > > light-headed and strange. I know now that the feeling is related to > > bradycardia and hypotension (HR 50's, BP 80's/30-40's). As the half-life > > decreases the circulating levels, my HR and BP began looking like my > > baseline (HR 70's, BP 140-150/80-90). When I feel that way, my radial > > pulse is almost not palpable. Laying down, of course, helps. So, now I am > > thinking that, on those days, my aldosterone is suppressed. Am I > > right? > > >>> > > >>>Another thing: Around 2003-4 or so, we started using > > Nesiritide (atrial natriuretic †" ANH stimulator) instead of Dobutrex and > > Primacor for our CHFers. In the Evolution article, you say that increased > > vascular pressures promotes natriuresis. So, it follows that these > > patients have decompensated and no longer respond to the body's > > compensatory mechanism, correct? Also, does this have something to do with > > the push for ACE inhibitors as the lead medication in treating > > HTN? > > >>> > > >>>One more question: I am post-menopausal but did have night > > sweats before menopause that I attributed to hormone levels. I still have > > night sweats but these are different. I wake up about every two hours. At > > first I feel almost afraid, my heart starts racing, then I feel completely > > strange, then I get really hot. The onset of another symptom ends the > > prior symptom. I've timed it from the fear feeling to the end. It lasts > > about 4-5 minutes. Then everything returns to normal. This happens most > > nights sometimes every two hours all night It even happens when I nap. It > > is what wakes me up. I researched the symptoms and was thinking there was > > a correlation to LH and FSH based on the q 2 hour cycle. I also considered > > a release of cortisol. Now I wonder if it is part and parcel of the PA. > > Any thoughts? Is aldosterone released in intervals? If so, what's the time > > frame? > > >>> > > >>>Finally, of the Stage IV symptoms, these are the ones I've > > experienced: profound hypokalemia, polyuria, drug resistant HTN, > > hand/feet/leg cramps, profound weakness, periodic paralysis (onset when I > > stand but then it subsides in a couple of minutes), arrhythmias, mild > > proteinuria, and alkaline urine. > > >>> > > >>>There is so much more I am > > probably leaving out, but I am sure you will ask the questions that will > > free that information. So, thank you for your time and consideration. I'm > > looking forward to the journey. > > >>> > > >>>Barbara Tatro > > >>> > > >>>Medical > > History > > >>> > > >>>1. Hypertension †" DX 1989 - age 42 †" Severe and resistant > > since DX > > >>>2. Right Renal Artery Stenosis (70%) †" 2009 > > >>>3. Atrophic > > right kidney > > >>>4. Adrenal adenoma †" Left 2.2 x 2.5; Right 2.1 x 1.2 > > >>>Right diagnosed 2-2000 (1.5); Left diagnosed 6-2009 and increased size > > of right adenoma (described as adrenal nodules) > > >>>5. Hypokalemia > > (profound †" 1st incidence 1991, documented 2008-2011) > > >>>6. Mild > > hypercalcemia > > >>>7. Hypomagnesemia > > >>>8. Micro hematuria (small) > > >>>9. > > Mild proteinuria > > >>>10. Aortic calcification > > >>>11. Heat > > Intolerance > > >>>12. Back †" T11-12 Central disc extrusion, mild central > > canal stenosis; L1-2 bulging disc with compression of thecal sac; L2-3 > > bulging disc compressing thecal sac; L3-4 bulging disc, retroliathesis, > > central canal stenosis biforaminal stenosis; L4-5 unroofed disc, > > spondyloliatheses, severe central canal and biforaminal stenosis; L5-S1 > > extruded disc, left and right foraminal stenosis > > >>>13. Left hip †" joint > > space narrowing and arthritic changes, subchondral sclerosis (rheumatoid > > v. osteoarthritis) > > >>>14. Left lateral leg neuropathy with atrophy > > >>>15. > > Falling > > >>>16. Pneumonia †" February, May, September 2011 > > >>>17. Bilateral > > otitis media †" February, May, September 2011 > > >>>18. COPD > > >>>19. HPV > > >>>20. > > GI bleed †" Diffuse gastritis †" 2002 secondary to NSAID therapy > > >>>21. > > Fuch's Corneal Dystrophy (left eye severe, right eye mild to > > moderate) > > >>>22. Basal cell carcinoma left cheek > > >>>23. Adenomyosis †" > > D & C x 3 1970's > > >>>24. Fractures †" right tibia, left thumb, spiral > > fracture right 4th toe > > >>>25. Seasonal allergies > > >>>26. Chronic > > pain > > >>>27. Depression, anxiety and panic attacks, `nervous breakdown' x3 > > †" first at age 19 †" about every 10 years thereafter †" last one 1985 > > >>>28. > > Severe childhood abuse and molestation > > >>>29. Smoker 1ppd x 40 > > years > > >>> > > >>>Surgeries > > >>>1. Exploratory lap, choleycystectomy - > > 1977 > > >>>2. Hysteroscopy †" 1995 > > >>>3. Removal basal cell carcinoma left > > cheek †" 2000 > > >>> > > >>>Family History > > >>>1. Father (deceased) †" CHF, multiple > > MI, multiple CVA, Resistant HTN, Fuch's Corneal Dystrophy, depression, > > HOH > > >>>2. Mother (deceased) †" HTN, cervical cancer, metastatic cancer > > >>>3. Sister (68) †" Fuch's corneal dystrophy, depression > > >>>4. Brother > > (66) †" Bladder cancer, thyroid cancer, HTN, Type II Diabetes, > > depression > > >>>5. Brother (60) †" HTN, Depression, dysrhythmia > > >>>6. Brother > > (46) - Dysrhythmia, depression > > >>> > > >>>Allergies > > >>>1. Serotonin †" Seizure, > > anaphylaxis, Serotonin Syndrome (ER x3) > > >>>2. Levaquin †" Levaquin > > Syndrome > > >>>3. Wellbutrin †" Cardiac dysrhythmia > > >>> > > >>>Prevention > > >>>1. > > Flu vaccine 11/2012 > > >>>2. Pneumonia vaccine 11/2010 > > >>> > > >>>Medications > > December - 2011 > > >>> > > >>>1. Lisinopril-Hctz 20/12.5 mg BID > > >>>2. Verapamil > > 120mg BID > > >>>3. Labetalol 200mg BID > > >>>4. Pravastatin 20mg Q night > > >>>5. > > Doxepin 75mg QD > > >>>6. ASA 81mg BID > > >>>7. Potassium 20 mEq BID > > >>>8. > > Doxepin 75 mg QD > > >>>9. Ibuprofen 800mg BID > > >>>10. Zyrtec 10 mg QD > > >>>11. > > Glucosam/Chon 1500/1200mg QD > > >>>12. Vit B12 1000mcg QD > > >>>13. Vit C 500mg > > QD > > >>>14. Magnesium 250mg BID > > >>>15. Multi-Vit 1 tab QD > > >>>16. Fish Oil > > 1000 mg BID > > >>>17. Ventolin Inhale 1-2 puffs PRN > > >>>18. Naproxen 440mg > > PRN > > >>> > > >>> > > >> > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 14, 2012 Report Share Posted January 14, 2012 Did a 24 hour urine test, dropped it off friday. Waiting to hear results...what values do I look for to see if I am DASHING well enough? Is that the urine test or another? > > > >> > > > >> > > > >>>Dear Dr. Grim, > > > >>> > > > >>>I am a 64-year-old female. I am a retired > > > surgical heart ICU CCRN. I returned to college at age 39, and obtained a > > > BSN. I also student taught A & P and Micro labs for 12 years > > > post-graduation at Indiana University NW. I relocated to Houston, TX in > > > 2001. During my nursing tenure, I worked in community hospitals and for > > > several prestigious institutions including Methodist Hospital, Texas > > > Medical Center, Houston, for and with DeBakey. I also worked for > > > Hazim Safi's AAA unit at Memorial Hermann while in Houston. I have > > > presented at several critical care consortiums and served as clinical > > > educator at many of the facilities where I worked. > > > >>> > > > >>>So… looking > > > back on this medical journey confounds me. I, of all people, should have > > > done the research and found the answer. I attribute part of this > > > phenomenon to the lack of computer skills. I bought my first computer in > > > 2000. I wasn't what I would consider `computer literate' for a few more > > > years. By this time, I was easily 15 years into my PA odyssey and > > > convinced by professionals I trusted that my right adenoma was just an > > > `incidental' finding and quite common. I pride myself in my knowledge base > > > and assessment skills, but I very clearly dropped the ball when it came to > > > me. > > > >>> > > > >>>I do not hold contempt for the doctors who led me astray. If I > > > couldn't see the writing on the wall, why should they. I will say this, in > > > 20+ years of critical care nursing I never once cared for a patient with > > > PA as a primary or secondary diagnosis and I rarely cared for a patient > > > whose home medications included Spironolactone. Fewer still were > > > prescribed Spiro during their hospitalization. > > > >>> > > > >>>The beginning of > > > the end: I was diagnosed with HTN during a routine screening to begin my > > > nursing clinicals (age 42). The person who diagnosed it was an itty bitty > > > nun who was about 104. Poor thing could barely inflate the cuff. Her first > > > reading: 170/104. I assumed the extended inflation time had something to > > > do with it and asked that she repeat it. She did. No change. The doctor > > > that followed confirmed the DX. Begin the litany of BP meds dispensed so > > > conservatively, I am surprised I didn't stroke while waiting. Every change > > > that was made required a waiting period and another visit. Finally, a few > > > years in, I showed some progress. BPs were generally 140-150's/80-90's and > > > that was on a good day. The doc took the standard approach: started with a > > > diuretic then added a CCB, ACE, and finally a b-blocker. See attachment > > > for current medications. The b-blocker was Labetalol. When this was added > > > (due to the alpha blocking), I completely stopped have the adrenalin > > > rushes I had for years †" so the offender was nor-epi and not epi? But this > > > created an anti-depressant dilemma: block it with one med, then hold it in > > > the synapse with another… hmmmm… the old come here, go away therapy. Any > > > suggestions because I am on both currently? > > > >>> > > > >>>From age 19 until my > > > diagnosis and treatment for clinical depression in 1985, I had repeated > > > episodes of depression, anxiety attacks, panic attacks, even agoraphobia. > > > When I was finally diagnosed, I was put on Doxepin and have taken it > > > intermittently since that time. My history includes severe child abuse and > > > molestation. So what do I do after I escaped? I, in essence, married my > > > father and the abuse and stress continued. I just kept throwing more logs > > > on the fire. I therefore attributed much of what I was experiencing to my > > > history. I assumed my resistant pressures were anxiety-driven. During this > > > time, I could feel the release of adrenalin. It hit my chest like > > > 360joules. Then the panic and anxiety would ensue. After reading The > > > Evolution, I see that psycho-social stress can produce adenomas. Huge > > > ah-ha moment for this critical care RN. > > > >>> > > > >>>During this time, I > > > suggested a possible pheochromocytoma diagnosis. With the uncontrollable > > > HTN and added microhematuria and mild proteinuria I was beginning to have > > > real concerns. Docs weren't buying that. Too rare. About as rare as PA. > > > But I kept pushing so they started chasing a Lupus diagnosis. The ANA was > > > negative and I was pronounced well, except for the psych issues > > > <sigh>. > > > >>> > > > >>>After graduation (1992), I went to work in a > > > community hospital med/surg ICU. At the same time, we moved and began > > > building the `dream house' we could now afford. My four children were > > > struggling to assimilate into a new environment and school. My oldest > > > daughter was living with us with her baby while her husband served in > > > Desert Storm. All four burners were full up and it wasn't long before I > > > began floundering. One night I went to bed. It felt like me HR was about > > > 200 and I could feel the PVCs. Each one made a pronounce thud in my chest > > > followed by a momentary brain haze. It got so intense I finally asked my > > > husband to take me to the ER. My potassium was 2.7. Their treatment of > > > cure was 20mEq of effervescent potassium po and serial labs. I was > > > released when my K+ hit 3.3. I was pronounced well and they sent me on my > > > way. > > > >>> > > > >>>I scheduled an appointment with my doctor who was still not > > > connecting the dots. He did add 20mEq of K+ daily to my meds. Things > > > stayed pretty much the same. On anti-depressants, then off, uncontrolled > > > HTN, micro hematuria, mild proteinuria, panic, anxiety off and on, same > > > stuff that everyone now considered my normal. > > > >>> > > > >>>We built the house, > > > kids were leaving one-by-one and the marriage had run its course. Divorce > > > was inevitable. During this period, I developed `severe' right flank pain. > > > It felt like if I could stick my finger inside my body up to my hand at > > > the level of my inferior rib, I could touch where the pain was located. > > > Now I get it. My doctor gave me some Vicodin which helped but I was > > > miserable, couldn't find a comfortable position and it went on for 2 > > > months. At that time he ordered a CT of my chest. God only knows why. The > > > right adrenal adenoma (or nodule as it was described) was uncovered. Still > > > not connecting the dots, him or me. > > > >>> > > > >>>That year I divorced and > > > relocated to Houston. I was happier and felt healthier. I was even able to > > > wean down my anti-hypertensives. This is when the issues with my back > > > began and the introduction of daily NSAIDs. It is now a concern for me > > > because I know there is an issue with combining NSAIDs and Spiro. Your > > > thoughts? > > > >>> > > > >>>More life changes. I moved back to Chicago October 2004 > > > and decided to give my failed marriage a second chance. It was less > > > stressful than it had been, but still acceptable. Soon, I started having a > > > lot of PVCs again. I was at work one night and decided to run a strip to > > > see if these were PACs of PVCs. They were PVCs (bigeminy, trigeminy, and > > > random). I had a nurse friend draw some blood and we sent it to lab. My > > > potassium was 2.8. I called the pharmacy and they sent me 100 mEq of K+. > > > It suppressed the PVCs for a few days but they returned. Again, I ran a > > > strip, drew blood, K+ was 3.0. Sent for a supplement and went to the > > > clinic. The doctor I had always seen left the Clinic, so I no longer had a > > > doctor. An Immediate Care physician saw me. He ordered a 24-hr Holter and > > > labs. The PVCs were ridiculously high. I know. I could feel every one. But > > > nothing was done. No follow-up, consultations, referrals, or > > > treatment. > > > >>> > > > >>>Things were deteriorating rapidly with the current > > > living situation, so I moved out. I began having severe lower leg and feet > > > cramps in 2008. I also was having frequent lower leg fasciculations, > > > particularly when I'd lay down. I started taking B12 for the cramping > > > which helped quite a bit. In January 2009 I moved to polis, MD to take > > > a job at s Hopkins. A death in the family brought me home again in > > > October 2009. I retired and it's been downhill ever since. > > > >>> > > > >>>Being > > > uninsured until July 2012 (Medicare), I was seeing a NP at a local > > > doc-in-a-box to get my prescriptions. I started having days filled with > > > PVCs and depression. I was started back on Doxepin. Labs showed my > > > potassium to be in the 3.0 to 3.2 range, a level that makes me > > > symptomatic. Knowing the cause, I finally just started treating it myself, > > > usually 80-120mEq over a day and a half and I would be okay for a couple > > > of weeks. It was during this time that it registered how often I was > > > urinating. It was so much that I finally bought a meter to check my BS. It > > > was and is normal as is my A1C. > > > >>> > > > >>>I needed a higher level of care so > > > I started seeing the PA at the doc-in-a-box thinking she would be > > > consulting with the in-house doctor regarding my care. After the initial > > > appointment, I was told they would no longer prescribe the Doxepin. The > > > doctor thought I was taking it for sleep or selling it, not sure which. I > > > also needed medication refills. The potassium called in was ½ my normal > > > dose. I freaked because I was almost out and having PVCs again. So I > > > gathered my history `evidence' and took it to the PA. She refused to > > > prescribe the correct amount after I told her I was self-medicating and > > > why with the proof in hand. After an embarrassing tete tete occurring in > > > front of staff and a waiting room full of patients, I stormed out. I asked > > > a friend pull a few strings (doctors won't see you if you're a self-pay > > > I've discovered) and I got in to see a family practice doc in September > > > 2011. > > > >>> > > > >>>Rather than have a staff member record my history > > > incorrectly, I put it in H & P format and handed it to the doctor. While > > > preparing the document, I decided to do some research on the causes of > > > chronic low potassium other than the obvious (thiazide diuretic, albuterol > > > inhaler, and recent rounds of prednisone for pneumonia). Imagine my > > > surprise when Conn's popped up and I finally connected the dots. I am THE > > > POSTER CHILD for Stage IV Conn's. > > > >>> > > > >>>When I had my appointment with > > > the family practice doc, I said, " The bilateral adrenal adenomas are > > > probably functional and it is highly likely that I have Conn's Syndrome " . > > > I told him about the low potassium, my symptoms, and how I had been > > > treating it. Much to my surprise and without labs to back up my claim, he > > > prescribed K+ supplements equal to my bi-tri-weekly fix. However, no PA > > > blood or urine labs were ordered and his primary concern was the right > > > renal artery stenosis. The way I viewed that: if my aorta showed > > > calcification in 2000, it is highly likely that the renal artery is also > > > calcified. I thought that was probable because I have been mildly > > > hypercalcemic for years. That I attributed to higher blood calcium levels > > > secondary to CCB therapy. Now I am not so sure. > > > >>> > > > >>>I do have a > > > question: In your Evolution article you state that one of the symptoms of > > > the 34-year-old female was a positive Chevostek and Trousseau. Aren't > > > those tests reflective of low blood calcium? Also, my lab abnormalities > > > are often part of the earth metal/alkaline earth metal periodic family. Is > > > there a correlation other than the valence numbers? > > > >>> > > > >>>Also, a few > > > days a month about an hour after I take my meds, I start feeling > > > light-headed and strange. I know now that the feeling is related to > > > bradycardia and hypotension (HR 50's, BP 80's/30-40's). As the half-life > > > decreases the circulating levels, my HR and BP began looking like my > > > baseline (HR 70's, BP 140-150/80-90). When I feel that way, my radial > > > pulse is almost not palpable. Laying down, of course, helps. So, now I am > > > thinking that, on those days, my aldosterone is suppressed. Am I > > > right? > > > >>> > > > >>>Another thing: Around 2003-4 or so, we started using > > > Nesiritide (atrial natriuretic †" ANH stimulator) instead of Dobutrex and > > > Primacor for our CHFers. In the Evolution article, you say that increased > > > vascular pressures promotes natriuresis. So, it follows that these > > > patients have decompensated and no longer respond to the body's > > > compensatory mechanism, correct? Also, does this have something to do with > > > the push for ACE inhibitors as the lead medication in treating > > > HTN? > > > >>> > > > >>>One more question: I am post-menopausal but did have night > > > sweats before menopause that I attributed to hormone levels. I still have > > > night sweats but these are different. I wake up about every two hours. At > > > first I feel almost afraid, my heart starts racing, then I feel completely > > > strange, then I get really hot. The onset of another symptom ends the > > > prior symptom. I've timed it from the fear feeling to the end. It lasts > > > about 4-5 minutes. Then everything returns to normal. This happens most > > > nights sometimes every two hours all night It even happens when I nap. It > > > is what wakes me up. I researched the symptoms and was thinking there was > > > a correlation to LH and FSH based on the q 2 hour cycle. I also considered > > > a release of cortisol. Now I wonder if it is part and parcel of the PA. > > > Any thoughts? Is aldosterone released in intervals? If so, what's the time > > > frame? > > > >>> > > > >>>Finally, of the Stage IV symptoms, these are the ones I've > > > experienced: profound hypokalemia, polyuria, drug resistant HTN, > > > hand/feet/leg cramps, profound weakness, periodic paralysis (onset when I > > > stand but then it subsides in a couple of minutes), arrhythmias, mild > > > proteinuria, and alkaline urine. > > > >>> > > > >>>There is so much more I am > > > probably leaving out, but I am sure you will ask the questions that will > > > free that information. So, thank you for your time and consideration. I'm > > > looking forward to the journey. > > > >>> > > > >>>Barbara Tatro > > > >>> > > > >>>Medical > > > History > > > >>> > > > >>>1. Hypertension †" DX 1989 - age 42 †" Severe and resistant > > > since DX > > > >>>2. Right Renal Artery Stenosis (70%) †" 2009 > > > >>>3. Atrophic > > > right kidney > > > >>>4. Adrenal adenoma †" Left 2.2 x 2.5; Right 2.1 x 1.2 > > > >>>Right diagnosed 2-2000 (1.5); Left diagnosed 6-2009 and increased size > > > of right adenoma (described as adrenal nodules) > > > >>>5. Hypokalemia > > > (profound †" 1st incidence 1991, documented 2008-2011) > > > >>>6. Mild > > > hypercalcemia > > > >>>7. Hypomagnesemia > > > >>>8. Micro hematuria (small) > > > >>>9. > > > Mild proteinuria > > > >>>10. Aortic calcification > > > >>>11. Heat > > > Intolerance > > > >>>12. Back †" T11-12 Central disc extrusion, mild central > > > canal stenosis; L1-2 bulging disc with compression of thecal sac; L2-3 > > > bulging disc compressing thecal sac; L3-4 bulging disc, retroliathesis, > > > central canal stenosis biforaminal stenosis; L4-5 unroofed disc, > > > spondyloliatheses, severe central canal and biforaminal stenosis; L5-S1 > > > extruded disc, left and right foraminal stenosis > > > >>>13. Left hip †" joint > > > space narrowing and arthritic changes, subchondral sclerosis (rheumatoid > > > v. osteoarthritis) > > > >>>14. Left lateral leg neuropathy with atrophy > > > >>>15. > > > Falling > > > >>>16. Pneumonia †" February, May, September 2011 > > > >>>17. Bilateral > > > otitis media †" February, May, September 2011 > > > >>>18. COPD > > > >>>19. HPV > > > >>>20. > > > GI bleed †" Diffuse gastritis †" 2002 secondary to NSAID therapy > > > >>>21. > > > Fuch's Corneal Dystrophy (left eye severe, right eye mild to > > > moderate) > > > >>>22. Basal cell carcinoma left cheek > > > >>>23. Adenomyosis †" > > > D & C x 3 1970's > > > >>>24. Fractures †" right tibia, left thumb, spiral > > > fracture right 4th toe > > > >>>25. Seasonal allergies > > > >>>26. Chronic > > > pain > > > >>>27. Depression, anxiety and panic attacks, `nervous breakdown' x3 > > > †" first at age 19 †" about every 10 years thereafter †" last one 1985 > > > >>>28. > > > Severe childhood abuse and molestation > > > >>>29. Smoker 1ppd x 40 > > > years > > > >>> > > > >>>Surgeries > > > >>>1. Exploratory lap, choleycystectomy - > > > 1977 > > > >>>2. Hysteroscopy †" 1995 > > > >>>3. Removal basal cell carcinoma left > > > cheek †" 2000 > > > >>> > > > >>>Family History > > > >>>1. Father (deceased) †" CHF, multiple > > > MI, multiple CVA, Resistant HTN, Fuch's Corneal Dystrophy, depression, > > > HOH > > > >>>2. Mother (deceased) †" HTN, cervical cancer, metastatic cancer > > > >>>3. Sister (68) †" Fuch's corneal dystrophy, depression > > > >>>4. Brother > > > (66) †" Bladder cancer, thyroid cancer, HTN, Type II Diabetes, > > > depression > > > >>>5. Brother (60) †" HTN, Depression, dysrhythmia > > > >>>6. Brother > > > (46) - Dysrhythmia, depression > > > >>> > > > >>>Allergies > > > >>>1. Serotonin †" Seizure, > > > anaphylaxis, Serotonin Syndrome (ER x3) > > > >>>2. Levaquin †" Levaquin > > > Syndrome > > > >>>3. Wellbutrin †" Cardiac dysrhythmia > > > >>> > > > >>>Prevention > > > >>>1. > > > Flu vaccine 11/2012 > > > >>>2. Pneumonia vaccine 11/2010 > > > >>> > > > >>>Medications > > > December - 2011 > > > >>> > > > >>>1. Lisinopril-Hctz 20/12.5 mg BID > > > >>>2. Verapamil > > > 120mg BID > > > >>>3. Labetalol 200mg BID > > > >>>4. Pravastatin 20mg Q night > > > >>>5. > > > Doxepin 75mg QD > > > >>>6. ASA 81mg BID > > > >>>7. Potassium 20 mEq BID > > > >>>8. > > > Doxepin 75 mg QD > > > >>>9. Ibuprofen 800mg BID > > > >>>10. Zyrtec 10 mg QD > > > >>>11. > > > Glucosam/Chon 1500/1200mg QD > > > >>>12. Vit B12 1000mcg QD > > > >>>13. Vit C 500mg > > > QD > > > >>>14. Magnesium 250mg BID > > > >>>15. Multi-Vit 1 tab QD > > > >>>16. Fish Oil > > > 1000 mg BID > > > >>>17. Ventolin Inhale 1-2 puffs PRN > > > >>>18. Naproxen 440mg > > > PRN > > > >>> > > > >>> > > > >> > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 14, 2012 Report Share Posted January 14, 2012 Depends on what they are checking. If checking sodium and K then this can be used to see if your are DASHING. Do you have a water softener or live where water has high sodium levels? > > > > >> > > > > >> > > > > >>>Dear Dr. Grim, > > > > >>> > > > > >>>I am a 64-year-old female. I am a retired > > > > surgical heart ICU CCRN. I returned to college at age 39, and obtained a > > > > BSN. I also student taught A & P and Micro labs for 12 years > > > > post-graduation at Indiana University NW. I relocated to Houston, TX in > > > > 2001. During my nursing tenure, I worked in community hospitals and for > > > > several prestigious institutions including Methodist Hospital, Texas > > > > Medical Center, Houston, for and with DeBakey. I also worked for > > > > Hazim Safi's AAA unit at Memorial Hermann while in Houston. I have > > > > presented at several critical care consortiums and served as clinical > > > > educator at many of the facilities where I worked. > > > > >>> > > > > >>>So… looking > > > > back on this medical journey confounds me. I, of all people, should have > > > > done the research and found the answer. I attribute part of this > > > > phenomenon to the lack of computer skills. I bought my first computer in > > > > 2000. I wasn't what I would consider `computer literate' for a few more > > > > years. By this time, I was easily 15 years into my PA odyssey and > > > > convinced by professionals I trusted that my right adenoma was just an > > > > `incidental' finding and quite common. I pride myself in my knowledge base > > > > and assessment skills, but I very clearly dropped the ball when it came to > > > > me. > > > > >>> > > > > >>>I do not hold contempt for the doctors who led me astray. If I > > > > couldn't see the writing on the wall, why should they. I will say this, in > > > > 20+ years of critical care nursing I never once cared for a patient with > > > > PA as a primary or secondary diagnosis and I rarely cared for a patient > > > > whose home medications included Spironolactone. Fewer still were > > > > prescribed Spiro during their hospitalization. > > > > >>> > > > > >>>The beginning of > > > > the end: I was diagnosed with HTN during a routine screening to begin my > > > > nursing clinicals (age 42). The person who diagnosed it was an itty bitty > > > > nun who was about 104. Poor thing could barely inflate the cuff. Her first > > > > reading: 170/104. I assumed the extended inflation time had something to > > > > do with it and asked that she repeat it. She did. No change. The doctor > > > > that followed confirmed the DX. Begin the litany of BP meds dispensed so > > > > conservatively, I am surprised I didn't stroke while waiting. Every change > > > > that was made required a waiting period and another visit. Finally, a few > > > > years in, I showed some progress. BPs were generally 140-150's/80-90's and > > > > that was on a good day. The doc took the standard approach: started with a > > > > diuretic then added a CCB, ACE, and finally a b-blocker. See attachment > > > > for current medications. The b-blocker was Labetalol. When this was added > > > > (due to the alpha blocking), I completely stopped have the adrenalin > > > > rushes I had for years †" so the offender was nor-epi and not epi? But this > > > > created an anti-depressant dilemma: block it with one med, then hold it in > > > > the synapse with another… hmmmm… the old come here, go away therapy. Any > > > > suggestions because I am on both currently? > > > > >>> > > > > >>>From age 19 until my > > > > diagnosis and treatment for clinical depression in 1985, I had repeated > > > > episodes of depression, anxiety attacks, panic attacks, even agoraphobia. > > > > When I was finally diagnosed, I was put on Doxepin and have taken it > > > > intermittently since that time. My history includes severe child abuse and > > > > molestation. So what do I do after I escaped? I, in essence, married my > > > > father and the abuse and stress continued. I just kept throwing more logs > > > > on the fire. I therefore attributed much of what I was experiencing to my > > > > history. I assumed my resistant pressures were anxiety-driven. During this > > > > time, I could feel the release of adrenalin. It hit my chest like > > > > 360joules. Then the panic and anxiety would ensue. After reading The > > > > Evolution, I see that psycho-social stress can produce adenomas. Huge > > > > ah-ha moment for this critical care RN. > > > > >>> > > > > >>>During this time, I > > > > suggested a possible pheochromocytoma diagnosis. With the uncontrollable > > > > HTN and added microhematuria and mild proteinuria I was beginning to have > > > > real concerns. Docs weren't buying that. Too rare. About as rare as PA. > > > > But I kept pushing so they started chasing a Lupus diagnosis. The ANA was > > > > negative and I was pronounced well, except for the psych issues > > > > <sigh>. > > > > >>> > > > > >>>After graduation (1992), I went to work in a > > > > community hospital med/surg ICU. At the same time, we moved and began > > > > building the `dream house' we could now afford. My four children were > > > > struggling to assimilate into a new environment and school. My oldest > > > > daughter was living with us with her baby while her husband served in > > > > Desert Storm. All four burners were full up and it wasn't long before I > > > > began floundering. One night I went to bed. It felt like me HR was about > > > > 200 and I could feel the PVCs. Each one made a pronounce thud in my chest > > > > followed by a momentary brain haze. It got so intense I finally asked my > > > > husband to take me to the ER. My potassium was 2.7. Their treatment of > > > > cure was 20mEq of effervescent potassium po and serial labs. I was > > > > released when my K+ hit 3.3. I was pronounced well and they sent me on my > > > > way. > > > > >>> > > > > >>>I scheduled an appointment with my doctor who was still not > > > > connecting the dots. He did add 20mEq of K+ daily to my meds. Things > > > > stayed pretty much the same. On anti-depressants, then off, uncontrolled > > > > HTN, micro hematuria, mild proteinuria, panic, anxiety off and on, same > > > > stuff that everyone now considered my normal. > > > > >>> > > > > >>>We built the house, > > > > kids were leaving one-by-one and the marriage had run its course. Divorce > > > > was inevitable. During this period, I developed `severe' right flank pain. > > > > It felt like if I could stick my finger inside my body up to my hand at > > > > the level of my inferior rib, I could touch where the pain was located. > > > > Now I get it. My doctor gave me some Vicodin which helped but I was > > > > miserable, couldn't find a comfortable position and it went on for 2 > > > > months. At that time he ordered a CT of my chest. God only knows why. The > > > > right adrenal adenoma (or nodule as it was described) was uncovered. Still > > > > not connecting the dots, him or me. > > > > >>> > > > > >>>That year I divorced and > > > > relocated to Houston. I was happier and felt healthier. I was even able to > > > > wean down my anti-hypertensives. This is when the issues with my back > > > > began and the introduction of daily NSAIDs. It is now a concern for me > > > > because I know there is an issue with combining NSAIDs and Spiro. Your > > > > thoughts? > > > > >>> > > > > >>>More life changes. I moved back to Chicago October 2004 > > > > and decided to give my failed marriage a second chance. It was less > > > > stressful than it had been, but still acceptable. Soon, I started having a > > > > lot of PVCs again. I was at work one night and decided to run a strip to > > > > see if these were PACs of PVCs. They were PVCs (bigeminy, trigeminy, and > > > > random). I had a nurse friend draw some blood and we sent it to lab. My > > > > potassium was 2.8. I called the pharmacy and they sent me 100 mEq of K+. > > > > It suppressed the PVCs for a few days but they returned. Again, I ran a > > > > strip, drew blood, K+ was 3.0. Sent for a supplement and went to the > > > > clinic. The doctor I had always seen left the Clinic, so I no longer had a > > > > doctor. An Immediate Care physician saw me. He ordered a 24-hr Holter and > > > > labs. The PVCs were ridiculously high. I know. I could feel every one. But > > > > nothing was done. No follow-up, consultations, referrals, or > > > > treatment. > > > > >>> > > > > >>>Things were deteriorating rapidly with the current > > > > living situation, so I moved out. I began having severe lower leg and feet > > > > cramps in 2008. I also was having frequent lower leg fasciculations, > > > > particularly when I'd lay down. I started taking B12 for the cramping > > > > which helped quite a bit. In January 2009 I moved to polis, MD to take > > > > a job at s Hopkins. A death in the family brought me home again in > > > > October 2009. I retired and it's been downhill ever since. > > > > >>> > > > > >>>Being > > > > uninsured until July 2012 (Medicare), I was seeing a NP at a local > > > > doc-in-a-box to get my prescriptions. I started having days filled with > > > > PVCs and depression. I was started back on Doxepin. Labs showed my > > > > potassium to be in the 3.0 to 3.2 range, a level that makes me > > > > symptomatic. Knowing the cause, I finally just started treating it myself, > > > > usually 80-120mEq over a day and a half and I would be okay for a couple > > > > of weeks. It was during this time that it registered how often I was > > > > urinating. It was so much that I finally bought a meter to check my BS. It > > > > was and is normal as is my A1C. > > > > >>> > > > > >>>I needed a higher level of care so > > > > I started seeing the PA at the doc-in-a-box thinking she would be > > > > consulting with the in-house doctor regarding my care. After the initial > > > > appointment, I was told they would no longer prescribe the Doxepin. The > > > > doctor thought I was taking it for sleep or selling it, not sure which. I > > > > also needed medication refills. The potassium called in was ½ my normal > > > > dose. I freaked because I was almost out and having PVCs again. So I > > > > gathered my history `evidence' and took it to the PA. She refused to > > > > prescribe the correct amount after I told her I was self-medicating and > > > > why with the proof in hand. After an embarrassing tete tete occurring in > > > > front of staff and a waiting room full of patients, I stormed out. I asked > > > > a friend pull a few strings (doctors won't see you if you're a self-pay > > > > I've discovered) and I got in to see a family practice doc in September > > > > 2011. > > > > >>> > > > > >>>Rather than have a staff member record my history > > > > incorrectly, I put it in H & P format and handed it to the doctor. While > > > > preparing the document, I decided to do some research on the causes of > > > > chronic low potassium other than the obvious (thiazide diuretic, albuterol > > > > inhaler, and recent rounds of prednisone for pneumonia). Imagine my > > > > surprise when Conn's popped up and I finally connected the dots. I am THE > > > > POSTER CHILD for Stage IV Conn's. > > > > >>> > > > > >>>When I had my appointment with > > > > the family practice doc, I said, " The bilateral adrenal adenomas are > > > > probably functional and it is highly likely that I have Conn's Syndrome " . > > > > I told him about the low potassium, my symptoms, and how I had been > > > > treating it. Much to my surprise and without labs to back up my claim, he > > > > prescribed K+ supplements equal to my bi-tri-weekly fix. However, no PA > > > > blood or urine labs were ordered and his primary concern was the right > > > > renal artery stenosis. The way I viewed that: if my aorta showed > > > > calcification in 2000, it is highly likely that the renal artery is also > > > > calcified. I thought that was probable because I have been mildly > > > > hypercalcemic for years. That I attributed to higher blood calcium levels > > > > secondary to CCB therapy. Now I am not so sure. > > > > >>> > > > > >>>I do have a > > > > question: In your Evolution article you state that one of the symptoms of > > > > the 34-year-old female was a positive Chevostek and Trousseau. Aren't > > > > those tests reflective of low blood calcium? Also, my lab abnormalities > > > > are often part of the earth metal/alkaline earth metal periodic family. Is > > > > there a correlation other than the valence numbers? > > > > >>> > > > > >>>Also, a few > > > > days a month about an hour after I take my meds, I start feeling > > > > light-headed and strange. I know now that the feeling is related to > > > > bradycardia and hypotension (HR 50's, BP 80's/30-40's). As the half-life > > > > decreases the circulating levels, my HR and BP began looking like my > > > > baseline (HR 70's, BP 140-150/80-90). When I feel that way, my radial > > > > pulse is almost not palpable. Laying down, of course, helps. So, now I am > > > > thinking that, on those days, my aldosterone is suppressed. Am I > > > > right? > > > > >>> > > > > >>>Another thing: Around 2003-4 or so, we started using > > > > Nesiritide (atrial natriuretic †" ANH stimulator) instead of Dobutrex and > > > > Primacor for our CHFers. In the Evolution article, you say that increased > > > > vascular pressures promotes natriuresis. So, it follows that these > > > > patients have decompensated and no longer respond to the body's > > > > compensatory mechanism, correct? Also, does this have something to do with > > > > the push for ACE inhibitors as the lead medication in treating > > > > HTN? > > > > >>> > > > > >>>One more question: I am post-menopausal but did have night > > > > sweats before menopause that I attributed to hormone levels. I still have > > > > night sweats but these are different. I wake up about every two hours. At > > > > first I feel almost afraid, my heart starts racing, then I feel completely > > > > strange, then I get really hot. The onset of another symptom ends the > > > > prior symptom. I've timed it from the fear feeling to the end. It lasts > > > > about 4-5 minutes. Then everything returns to normal. This happens most > > > > nights sometimes every two hours all night It even happens when I nap. It > > > > is what wakes me up. I researched the symptoms and was thinking there was > > > > a correlation to LH and FSH based on the q 2 hour cycle. I also considered > > > > a release of cortisol. Now I wonder if it is part and parcel of the PA. > > > > Any thoughts? Is aldosterone released in intervals? If so, what's the time > > > > frame? > > > > >>> > > > > >>>Finally, of the Stage IV symptoms, these are the ones I've > > > > experienced: profound hypokalemia, polyuria, drug resistant HTN, > > > > hand/feet/leg cramps, profound weakness, periodic paralysis (onset when I > > > > stand but then it subsides in a couple of minutes), arrhythmias, mild > > > > proteinuria, and alkaline urine. > > > > >>> > > > > >>>There is so much more I am > > > > probably leaving out, but I am sure you will ask the questions that will > > > > free that information. So, thank you for your time and consideration. I'm > > > > looking forward to the journey. > > > > >>> > > > > >>>Barbara Tatro > > > > >>> > > > > >>>Medical > > > > History > > > > >>> > > > > >>>1. Hypertension †" DX 1989 - age 42 †" Severe and resistant > > > > since DX > > > > >>>2. Right Renal Artery Stenosis (70%) †" 2009 > > > > >>>3. Atrophic > > > > right kidney > > > > >>>4. Adrenal adenoma †" Left 2.2 x 2.5; Right 2.1 x 1.2 > > > > >>>Right diagnosed 2-2000 (1.5); Left diagnosed 6-2009 and increased size > > > > of right adenoma (described as adrenal nodules) > > > > >>>5. Hypokalemia > > > > (profound †" 1st incidence 1991, documented 2008-2011) > > > > >>>6. Mild > > > > hypercalcemia > > > > >>>7. Hypomagnesemia > > > > >>>8. Micro hematuria (small) > > > > >>>9. > > > > Mild proteinuria > > > > >>>10. Aortic calcification > > > > >>>11. Heat > > > > Intolerance > > > > >>>12. Back †" T11-12 Central disc extrusion, mild central > > > > canal stenosis; L1-2 bulging disc with compression of thecal sac; L2-3 > > > > bulging disc compressing thecal sac; L3-4 bulging disc, retroliathesis, > > > > central canal stenosis biforaminal stenosis; L4-5 unroofed disc, > > > > spondyloliatheses, severe central canal and biforaminal stenosis; L5-S1 > > > > extruded disc, left and right foraminal stenosis > > > > >>>13. Left hip †" joint > > > > space narrowing and arthritic changes, subchondral sclerosis (rheumatoid > > > > v. osteoarthritis) > > > > >>>14. Left lateral leg neuropathy with atrophy > > > > >>>15. > > > > Falling > > > > >>>16. Pneumonia †" February, May, September 2011 > > > > >>>17. Bilateral > > > > otitis media †" February, May, September 2011 > > > > >>>18. COPD > > > > >>>19. HPV > > > > >>>20. > > > > GI bleed †" Diffuse gastritis †" 2002 secondary to NSAID therapy > > > > >>>21. > > > > Fuch's Corneal Dystrophy (left eye severe, right eye mild to > > > > moderate) > > > > >>>22. Basal cell carcinoma left cheek > > > > >>>23. Adenomyosis †" > > > > D & C x 3 1970's > > > > >>>24. Fractures †" right tibia, left thumb, spiral > > > > fracture right 4th toe > > > > >>>25. Seasonal allergies > > > > >>>26. Chronic > > > > pain > > > > >>>27. Depression, anxiety and panic attacks, `nervous breakdown' x3 > > > > †" first at age 19 †" about every 10 years thereafter †" last one 1985 > > > > >>>28. > > > > Severe childhood abuse and molestation > > > > >>>29. Smoker 1ppd x 40 > > > > years > > > > >>> > > > > >>>Surgeries > > > > >>>1. Exploratory lap, choleycystectomy - > > > > 1977 > > > > >>>2. Hysteroscopy †" 1995 > > > > >>>3. Removal basal cell carcinoma left > > > > cheek †" 2000 > > > > >>> > > > > >>>Family History > > > > >>>1. Father (deceased) †" CHF, multiple > > > > MI, multiple CVA, Resistant HTN, Fuch's Corneal Dystrophy, depression, > > > > HOH > > > > >>>2. Mother (deceased) †" HTN, cervical cancer, metastatic cancer > > > > >>>3. Sister (68) †" Fuch's corneal dystrophy, depression > > > > >>>4. Brother > > > > (66) †" Bladder cancer, thyroid cancer, HTN, Type II Diabetes, > > > > depression > > > > >>>5. Brother (60) †" HTN, Depression, dysrhythmia > > > > >>>6. Brother > > > > (46) - Dysrhythmia, depression > > > > >>> > > > > >>>Allergies > > > > >>>1. Serotonin †" Seizure, > > > > anaphylaxis, Serotonin Syndrome (ER x3) > > > > >>>2. Levaquin †" Levaquin > > > > Syndrome > > > > >>>3. Wellbutrin †" Cardiac dysrhythmia > > > > >>> > > > > >>>Prevention > > > > >>>1. > > > > Flu vaccine 11/2012 > > > > >>>2. Pneumonia vaccine 11/2010 > > > > >>> > > > > >>>Medications > > > > December - 2011 > > > > >>> > > > > >>>1. Lisinopril-Hctz 20/12.5 mg BID > > > > >>>2. Verapamil > > > > 120mg BID > > > > >>>3. Labetalol 200mg BID > > > > >>>4. Pravastatin 20mg Q night > > > > >>>5. > > > > Doxepin 75mg QD > > > > >>>6. ASA 81mg BID > > > > >>>7. Potassium 20 mEq BID > > > > >>>8. > > > > Doxepin 75 mg QD > > > > >>>9. Ibuprofen 800mg BID > > > > >>>10. Zyrtec 10 mg QD > > > > >>>11. > > > > Glucosam/Chon 1500/1200mg QD > > > > >>>12. Vit B12 1000mcg QD > > > > >>>13. Vit C 500mg > > > > QD > > > > >>>14. Magnesium 250mg BID > > > > >>>15. Multi-Vit 1 tab QD > > > > >>>16. Fish Oil > > > > 1000 mg BID > > > > >>>17. Ventolin Inhale 1-2 puffs PRN > > > > >>>18. Naproxen 440mg > > > > PRN > > > > >>> > > > > >>> > > > > >> > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 14, 2012 Report Share Posted January 14, 2012 no water softener, we use a Brita water filtering system. What values of sodium and k am I looking for? They are testing for adolsterone, meta something, and catacholamine, as well as a micro somthing panel. > > > > > >> > > > > > >> > > > > > >>>Dear Dr. Grim, > > > > > >>> > > > > > >>>I am a 64-year-old female. I am a retired > > > > > surgical heart ICU CCRN. I returned to college at age 39, and obtained a > > > > > BSN. I also student taught A & P and Micro labs for 12 years > > > > > post-graduation at Indiana University NW. I relocated to Houston, TX in > > > > > 2001. During my nursing tenure, I worked in community hospitals and for > > > > > several prestigious institutions including Methodist Hospital, Texas > > > > > Medical Center, Houston, for and with DeBakey. I also worked for > > > > > Hazim Safi's AAA unit at Memorial Hermann while in Houston. I have > > > > > presented at several critical care consortiums and served as clinical > > > > > educator at many of the facilities where I worked. > > > > > >>> > > > > > >>>So… looking > > > > > back on this medical journey confounds me. I, of all people, should have > > > > > done the research and found the answer. I attribute part of this > > > > > phenomenon to the lack of computer skills. I bought my first computer in > > > > > 2000. I wasn't what I would consider `computer literate' for a few more > > > > > years. By this time, I was easily 15 years into my PA odyssey and > > > > > convinced by professionals I trusted that my right adenoma was just an > > > > > `incidental' finding and quite common. I pride myself in my knowledge base > > > > > and assessment skills, but I very clearly dropped the ball when it came to > > > > > me. > > > > > >>> > > > > > >>>I do not hold contempt for the doctors who led me astray. If I > > > > > couldn't see the writing on the wall, why should they. I will say this, in > > > > > 20+ years of critical care nursing I never once cared for a patient with > > > > > PA as a primary or secondary diagnosis and I rarely cared for a patient > > > > > whose home medications included Spironolactone. Fewer still were > > > > > prescribed Spiro during their hospitalization. > > > > > >>> > > > > > >>>The beginning of > > > > > the end: I was diagnosed with HTN during a routine screening to begin my > > > > > nursing clinicals (age 42). The person who diagnosed it was an itty bitty > > > > > nun who was about 104. Poor thing could barely inflate the cuff. Her first > > > > > reading: 170/104. I assumed the extended inflation time had something to > > > > > do with it and asked that she repeat it. She did. No change. The doctor > > > > > that followed confirmed the DX. Begin the litany of BP meds dispensed so > > > > > conservatively, I am surprised I didn't stroke while waiting. Every change > > > > > that was made required a waiting period and another visit. Finally, a few > > > > > years in, I showed some progress. BPs were generally 140-150's/80-90's and > > > > > that was on a good day. The doc took the standard approach: started with a > > > > > diuretic then added a CCB, ACE, and finally a b-blocker. See attachment > > > > > for current medications. The b-blocker was Labetalol. When this was added > > > > > (due to the alpha blocking), I completely stopped have the adrenalin > > > > > rushes I had for years †" so the offender was nor-epi and not epi? But this > > > > > created an anti-depressant dilemma: block it with one med, then hold it in > > > > > the synapse with another… hmmmm… the old come here, go away therapy. Any > > > > > suggestions because I am on both currently? > > > > > >>> > > > > > >>>From age 19 until my > > > > > diagnosis and treatment for clinical depression in 1985, I had repeated > > > > > episodes of depression, anxiety attacks, panic attacks, even agoraphobia. > > > > > When I was finally diagnosed, I was put on Doxepin and have taken it > > > > > intermittently since that time. My history includes severe child abuse and > > > > > molestation. So what do I do after I escaped? I, in essence, married my > > > > > father and the abuse and stress continued. I just kept throwing more logs > > > > > on the fire. I therefore attributed much of what I was experiencing to my > > > > > history. I assumed my resistant pressures were anxiety-driven. During this > > > > > time, I could feel the release of adrenalin. It hit my chest like > > > > > 360joules. Then the panic and anxiety would ensue. After reading The > > > > > Evolution, I see that psycho-social stress can produce adenomas. Huge > > > > > ah-ha moment for this critical care RN. > > > > > >>> > > > > > >>>During this time, I > > > > > suggested a possible pheochromocytoma diagnosis. With the uncontrollable > > > > > HTN and added microhematuria and mild proteinuria I was beginning to have > > > > > real concerns. Docs weren't buying that. Too rare. About as rare as PA. > > > > > But I kept pushing so they started chasing a Lupus diagnosis. The ANA was > > > > > negative and I was pronounced well, except for the psych issues > > > > > <sigh>. > > > > > >>> > > > > > >>>After graduation (1992), I went to work in a > > > > > community hospital med/surg ICU. At the same time, we moved and began > > > > > building the `dream house' we could now afford. My four children were > > > > > struggling to assimilate into a new environment and school. My oldest > > > > > daughter was living with us with her baby while her husband served in > > > > > Desert Storm. All four burners were full up and it wasn't long before I > > > > > began floundering. One night I went to bed. It felt like me HR was about > > > > > 200 and I could feel the PVCs. Each one made a pronounce thud in my chest > > > > > followed by a momentary brain haze. It got so intense I finally asked my > > > > > husband to take me to the ER. My potassium was 2.7. Their treatment of > > > > > cure was 20mEq of effervescent potassium po and serial labs. I was > > > > > released when my K+ hit 3.3. I was pronounced well and they sent me on my > > > > > way. > > > > > >>> > > > > > >>>I scheduled an appointment with my doctor who was still not > > > > > connecting the dots. He did add 20mEq of K+ daily to my meds. Things > > > > > stayed pretty much the same. On anti-depressants, then off, uncontrolled > > > > > HTN, micro hematuria, mild proteinuria, panic, anxiety off and on, same > > > > > stuff that everyone now considered my normal. > > > > > >>> > > > > > >>>We built the house, > > > > > kids were leaving one-by-one and the marriage had run its course. Divorce > > > > > was inevitable. During this period, I developed `severe' right flank pain. > > > > > It felt like if I could stick my finger inside my body up to my hand at > > > > > the level of my inferior rib, I could touch where the pain was located. > > > > > Now I get it. My doctor gave me some Vicodin which helped but I was > > > > > miserable, couldn't find a comfortable position and it went on for 2 > > > > > months. At that time he ordered a CT of my chest. God only knows why. The > > > > > right adrenal adenoma (or nodule as it was described) was uncovered. Still > > > > > not connecting the dots, him or me. > > > > > >>> > > > > > >>>That year I divorced and > > > > > relocated to Houston. I was happier and felt healthier. I was even able to > > > > > wean down my anti-hypertensives. This is when the issues with my back > > > > > began and the introduction of daily NSAIDs. It is now a concern for me > > > > > because I know there is an issue with combining NSAIDs and Spiro. Your > > > > > thoughts? > > > > > >>> > > > > > >>>More life changes. I moved back to Chicago October 2004 > > > > > and decided to give my failed marriage a second chance. It was less > > > > > stressful than it had been, but still acceptable. Soon, I started having a > > > > > lot of PVCs again. I was at work one night and decided to run a strip to > > > > > see if these were PACs of PVCs. They were PVCs (bigeminy, trigeminy, and > > > > > random). I had a nurse friend draw some blood and we sent it to lab. My > > > > > potassium was 2.8. I called the pharmacy and they sent me 100 mEq of K+. > > > > > It suppressed the PVCs for a few days but they returned. Again, I ran a > > > > > strip, drew blood, K+ was 3.0. Sent for a supplement and went to the > > > > > clinic. The doctor I had always seen left the Clinic, so I no longer had a > > > > > doctor. An Immediate Care physician saw me. He ordered a 24-hr Holter and > > > > > labs. The PVCs were ridiculously high. I know. I could feel every one. But > > > > > nothing was done. No follow-up, consultations, referrals, or > > > > > treatment. > > > > > >>> > > > > > >>>Things were deteriorating rapidly with the current > > > > > living situation, so I moved out. I began having severe lower leg and feet > > > > > cramps in 2008. I also was having frequent lower leg fasciculations, > > > > > particularly when I'd lay down. I started taking B12 for the cramping > > > > > which helped quite a bit. In January 2009 I moved to polis, MD to take > > > > > a job at s Hopkins. A death in the family brought me home again in > > > > > October 2009. I retired and it's been downhill ever since. > > > > > >>> > > > > > >>>Being > > > > > uninsured until July 2012 (Medicare), I was seeing a NP at a local > > > > > doc-in-a-box to get my prescriptions. I started having days filled with > > > > > PVCs and depression. I was started back on Doxepin. Labs showed my > > > > > potassium to be in the 3.0 to 3.2 range, a level that makes me > > > > > symptomatic. Knowing the cause, I finally just started treating it myself, > > > > > usually 80-120mEq over a day and a half and I would be okay for a couple > > > > > of weeks. It was during this time that it registered how often I was > > > > > urinating. It was so much that I finally bought a meter to check my BS. It > > > > > was and is normal as is my A1C. > > > > > >>> > > > > > >>>I needed a higher level of care so > > > > > I started seeing the PA at the doc-in-a-box thinking she would be > > > > > consulting with the in-house doctor regarding my care. After the initial > > > > > appointment, I was told they would no longer prescribe the Doxepin. The > > > > > doctor thought I was taking it for sleep or selling it, not sure which. I > > > > > also needed medication refills. The potassium called in was ½ my normal > > > > > dose. I freaked because I was almost out and having PVCs again. So I > > > > > gathered my history `evidence' and took it to the PA. She refused to > > > > > prescribe the correct amount after I told her I was self-medicating and > > > > > why with the proof in hand. After an embarrassing tete tete occurring in > > > > > front of staff and a waiting room full of patients, I stormed out. I asked > > > > > a friend pull a few strings (doctors won't see you if you're a self-pay > > > > > I've discovered) and I got in to see a family practice doc in September > > > > > 2011. > > > > > >>> > > > > > >>>Rather than have a staff member record my history > > > > > incorrectly, I put it in H & P format and handed it to the doctor. While > > > > > preparing the document, I decided to do some research on the causes of > > > > > chronic low potassium other than the obvious (thiazide diuretic, albuterol > > > > > inhaler, and recent rounds of prednisone for pneumonia). Imagine my > > > > > surprise when Conn's popped up and I finally connected the dots. I am THE > > > > > POSTER CHILD for Stage IV Conn's. > > > > > >>> > > > > > >>>When I had my appointment with > > > > > the family practice doc, I said, " The bilateral adrenal adenomas are > > > > > probably functional and it is highly likely that I have Conn's Syndrome " . > > > > > I told him about the low potassium, my symptoms, and how I had been > > > > > treating it. Much to my surprise and without labs to back up my claim, he > > > > > prescribed K+ supplements equal to my bi-tri-weekly fix. However, no PA > > > > > blood or urine labs were ordered and his primary concern was the right > > > > > renal artery stenosis. The way I viewed that: if my aorta showed > > > > > calcification in 2000, it is highly likely that the renal artery is also > > > > > calcified. I thought that was probable because I have been mildly > > > > > hypercalcemic for years. That I attributed to higher blood calcium levels > > > > > secondary to CCB therapy. Now I am not so sure. > > > > > >>> > > > > > >>>I do have a > > > > > question: In your Evolution article you state that one of the symptoms of > > > > > the 34-year-old female was a positive Chevostek and Trousseau. Aren't > > > > > those tests reflective of low blood calcium? Also, my lab abnormalities > > > > > are often part of the earth metal/alkaline earth metal periodic family. Is > > > > > there a correlation other than the valence numbers? > > > > > >>> > > > > > >>>Also, a few > > > > > days a month about an hour after I take my meds, I start feeling > > > > > light-headed and strange. I know now that the feeling is related to > > > > > bradycardia and hypotension (HR 50's, BP 80's/30-40's). As the half-life > > > > > decreases the circulating levels, my HR and BP began looking like my > > > > > baseline (HR 70's, BP 140-150/80-90). When I feel that way, my radial > > > > > pulse is almost not palpable. Laying down, of course, helps. So, now I am > > > > > thinking that, on those days, my aldosterone is suppressed. Am I > > > > > right? > > > > > >>> > > > > > >>>Another thing: Around 2003-4 or so, we started using > > > > > Nesiritide (atrial natriuretic †" ANH stimulator) instead of Dobutrex and > > > > > Primacor for our CHFers. In the Evolution article, you say that increased > > > > > vascular pressures promotes natriuresis. So, it follows that these > > > > > patients have decompensated and no longer respond to the body's > > > > > compensatory mechanism, correct? Also, does this have something to do with > > > > > the push for ACE inhibitors as the lead medication in treating > > > > > HTN? > > > > > >>> > > > > > >>>One more question: I am post-menopausal but did have night > > > > > sweats before menopause that I attributed to hormone levels. I still have > > > > > night sweats but these are different. I wake up about every two hours. At > > > > > first I feel almost afraid, my heart starts racing, then I feel completely > > > > > strange, then I get really hot. The onset of another symptom ends the > > > > > prior symptom. I've timed it from the fear feeling to the end. It lasts > > > > > about 4-5 minutes. Then everything returns to normal. This happens most > > > > > nights sometimes every two hours all night It even happens when I nap. It > > > > > is what wakes me up. I researched the symptoms and was thinking there was > > > > > a correlation to LH and FSH based on the q 2 hour cycle. I also considered > > > > > a release of cortisol. Now I wonder if it is part and parcel of the PA. > > > > > Any thoughts? Is aldosterone released in intervals? If so, what's the time > > > > > frame? > > > > > >>> > > > > > >>>Finally, of the Stage IV symptoms, these are the ones I've > > > > > experienced: profound hypokalemia, polyuria, drug resistant HTN, > > > > > hand/feet/leg cramps, profound weakness, periodic paralysis (onset when I > > > > > stand but then it subsides in a couple of minutes), arrhythmias, mild > > > > > proteinuria, and alkaline urine. > > > > > >>> > > > > > >>>There is so much more I am > > > > > probably leaving out, but I am sure you will ask the questions that will > > > > > free that information. So, thank you for your time and consideration. I'm > > > > > looking forward to the journey. > > > > > >>> > > > > > >>>Barbara Tatro > > > > > >>> > > > > > >>>Medical > > > > > History > > > > > >>> > > > > > >>>1. Hypertension †" DX 1989 - age 42 †" Severe and resistant > > > > > since DX > > > > > >>>2. Right Renal Artery Stenosis (70%) †" 2009 > > > > > >>>3. Atrophic > > > > > right kidney > > > > > >>>4. Adrenal adenoma †" Left 2.2 x 2.5; Right 2.1 x 1.2 > > > > > >>>Right diagnosed 2-2000 (1.5); Left diagnosed 6-2009 and increased size > > > > > of right adenoma (described as adrenal nodules) > > > > > >>>5. Hypokalemia > > > > > (profound †" 1st incidence 1991, documented 2008-2011) > > > > > >>>6. Mild > > > > > hypercalcemia > > > > > >>>7. Hypomagnesemia > > > > > >>>8. Micro hematuria (small) > > > > > >>>9. > > > > > Mild proteinuria > > > > > >>>10. Aortic calcification > > > > > >>>11. Heat > > > > > Intolerance > > > > > >>>12. Back †" T11-12 Central disc extrusion, mild central > > > > > canal stenosis; L1-2 bulging disc with compression of thecal sac; L2-3 > > > > > bulging disc compressing thecal sac; L3-4 bulging disc, retroliathesis, > > > > > central canal stenosis biforaminal stenosis; L4-5 unroofed disc, > > > > > spondyloliatheses, severe central canal and biforaminal stenosis; L5-S1 > > > > > extruded disc, left and right foraminal stenosis > > > > > >>>13. Left hip †" joint > > > > > space narrowing and arthritic changes, subchondral sclerosis (rheumatoid > > > > > v. osteoarthritis) > > > > > >>>14. Left lateral leg neuropathy with atrophy > > > > > >>>15. > > > > > Falling > > > > > >>>16. Pneumonia †" February, May, September 2011 > > > > > >>>17. Bilateral > > > > > otitis media †" February, May, September 2011 > > > > > >>>18. COPD > > > > > >>>19. HPV > > > > > >>>20. > > > > > GI bleed †" Diffuse gastritis †" 2002 secondary to NSAID therapy > > > > > >>>21. > > > > > Fuch's Corneal Dystrophy (left eye severe, right eye mild to > > > > > moderate) > > > > > >>>22. Basal cell carcinoma left cheek > > > > > >>>23. Adenomyosis †" > > > > > D & C x 3 1970's > > > > > >>>24. Fractures †" right tibia, left thumb, spiral > > > > > fracture right 4th toe > > > > > >>>25. Seasonal allergies > > > > > >>>26. Chronic > > > > > pain > > > > > >>>27. Depression, anxiety and panic attacks, `nervous breakdown' x3 > > > > > †" first at age 19 †" about every 10 years thereafter †" last one 1985 > > > > > >>>28. > > > > > Severe childhood abuse and molestation > > > > > >>>29. Smoker 1ppd x 40 > > > > > years > > > > > >>> > > > > > >>>Surgeries > > > > > >>>1. Exploratory lap, choleycystectomy - > > > > > 1977 > > > > > >>>2. Hysteroscopy †" 1995 > > > > > >>>3. Removal basal cell carcinoma left > > > > > cheek †" 2000 > > > > > >>> > > > > > >>>Family History > > > > > >>>1. Father (deceased) †" CHF, multiple > > > > > MI, multiple CVA, Resistant HTN, Fuch's Corneal Dystrophy, depression, > > > > > HOH > > > > > >>>2. Mother (deceased) †" HTN, cervical cancer, metastatic cancer > > > > > >>>3. Sister (68) †" Fuch's corneal dystrophy, depression > > > > > >>>4. Brother > > > > > (66) †" Bladder cancer, thyroid cancer, HTN, Type II Diabetes, > > > > > depression > > > > > >>>5. Brother (60) †" HTN, Depression, dysrhythmia > > > > > >>>6. Brother > > > > > (46) - Dysrhythmia, depression > > > > > >>> > > > > > >>>Allergies > > > > > >>>1. Serotonin †" Seizure, > > > > > anaphylaxis, Serotonin Syndrome (ER x3) > > > > > >>>2. Levaquin †" Levaquin > > > > > Syndrome > > > > > >>>3. Wellbutrin †" Cardiac dysrhythmia > > > > > >>> > > > > > >>>Prevention > > > > > >>>1. > > > > > Flu vaccine 11/2012 > > > > > >>>2. Pneumonia vaccine 11/2010 > > > > > >>> > > > > > >>>Medications > > > > > December - 2011 > > > > > >>> > > > > > >>>1. Lisinopril-Hctz 20/12.5 mg BID > > > > > >>>2. Verapamil > > > > > 120mg BID > > > > > >>>3. Labetalol 200mg BID > > > > > >>>4. Pravastatin 20mg Q night > > > > > >>>5. > > > > > Doxepin 75mg QD > > > > > >>>6. ASA 81mg BID > > > > > >>>7. Potassium 20 mEq BID > > > > > >>>8. > > > > > Doxepin 75 mg QD > > > > > >>>9. Ibuprofen 800mg BID > > > > > >>>10. Zyrtec 10 mg QD > > > > > >>>11. > > > > > Glucosam/Chon 1500/1200mg QD > > > > > >>>12. Vit B12 1000mcg QD > > > > > >>>13. Vit C 500mg > > > > > QD > > > > > >>>14. Magnesium 250mg BID > > > > > >>>15. Multi-Vit 1 tab QD > > > > > >>>16. Fish Oil > > > > > 1000 mg BID > > > > > >>>17. Ventolin Inhale 1-2 puffs PRN > > > > > >>>18. Naproxen 440mg > > > > > PRN > > > > > >>> > > > > > >>> > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 15, 2012 Report Share Posted January 15, 2012 Dr Grim can tell you relationship between sodium and k if dashing. > > > > > > >> > > > > > > >> > > > > > > >>>Dear Dr. Grim, > > > > > > >>> > > > > > > >>>I am a 64-year-old female. I am a retired > > > > > > surgical heart ICU CCRN. I returned to college at age 39, and obtained a > > > > > > BSN. I also student taught A & P and Micro labs for 12 years > > > > > > post-graduation at Indiana University NW. I relocated to Houston, TX in > > > > > > 2001. During my nursing tenure, I worked in community hospitals and for > > > > > > several prestigious institutions including Methodist Hospital, Texas > > > > > > Medical Center, Houston, for and with DeBakey. I also worked for > > > > > > Hazim Safi's AAA unit at Memorial Hermann while in Houston. I have > > > > > > presented at several critical care consortiums and served as clinical > > > > > > educator at many of the facilities where I worked. > > > > > > >>> > > > > > > >>>So… looking > > > > > > back on this medical journey confounds me. I, of all people, should have > > > > > > done the research and found the answer. I attribute part of this > > > > > > phenomenon to the lack of computer skills. I bought my first computer in > > > > > > 2000. I wasn't what I would consider `computer literate' for a few more > > > > > > years. By this time, I was easily 15 years into my PA odyssey and > > > > > > convinced by professionals I trusted that my right adenoma was just an > > > > > > `incidental' finding and quite common. I pride myself in my knowledge base > > > > > > and assessment skills, but I very clearly dropped the ball when it came to > > > > > > me. > > > > > > >>> > > > > > > >>>I do not hold contempt for the doctors who led me astray. If I > > > > > > couldn't see the writing on the wall, why should they. I will say this, in > > > > > > 20+ years of critical care nursing I never once cared for a patient with > > > > > > PA as a primary or secondary diagnosis and I rarely cared for a patient > > > > > > whose home medications included Spironolactone. Fewer still were > > > > > > prescribed Spiro during their hospitalization. > > > > > > >>> > > > > > > >>>The beginning of > > > > > > the end: I was diagnosed with HTN during a routine screening to begin my > > > > > > nursing clinicals (age 42). The person who diagnosed it was an itty bitty > > > > > > nun who was about 104. Poor thing could barely inflate the cuff. Her first > > > > > > reading: 170/104. I assumed the extended inflation time had something to > > > > > > do with it and asked that she repeat it. She did. No change. The doctor > > > > > > that followed confirmed the DX. Begin the litany of BP meds dispensed so > > > > > > conservatively, I am surprised I didn't stroke while waiting. Every change > > > > > > that was made required a waiting period and another visit. Finally, a few > > > > > > years in, I showed some progress. BPs were generally 140-150's/80-90's and > > > > > > that was on a good day. The doc took the standard approach: started with a > > > > > > diuretic then added a CCB, ACE, and finally a b-blocker. See attachment > > > > > > for current medications. The b-blocker was Labetalol. When this was added > > > > > > (due to the alpha blocking), I completely stopped have the adrenalin > > > > > > rushes I had for years †" so the offender was nor-epi and not epi? But this > > > > > > created an anti-depressant dilemma: block it with one med, then hold it in > > > > > > the synapse with another… hmmmm… the old come here, go away therapy. Any > > > > > > suggestions because I am on both currently? > > > > > > >>> > > > > > > >>>From age 19 until my > > > > > > diagnosis and treatment for clinical depression in 1985, I had repeated > > > > > > episodes of depression, anxiety attacks, panic attacks, even agoraphobia. > > > > > > When I was finally diagnosed, I was put on Doxepin and have taken it > > > > > > intermittently since that time. My history includes severe child abuse and > > > > > > molestation. So what do I do after I escaped? I, in essence, married my > > > > > > father and the abuse and stress continued. I just kept throwing more logs > > > > > > on the fire. I therefore attributed much of what I was experiencing to my > > > > > > history. I assumed my resistant pressures were anxiety-driven. During this > > > > > > time, I could feel the release of adrenalin. It hit my chest like > > > > > > 360joules. Then the panic and anxiety would ensue. After reading The > > > > > > Evolution, I see that psycho-social stress can produce adenomas. Huge > > > > > > ah-ha moment for this critical care RN. > > > > > > >>> > > > > > > >>>During this time, I > > > > > > suggested a possible pheochromocytoma diagnosis. With the uncontrollable > > > > > > HTN and added microhematuria and mild proteinuria I was beginning to have > > > > > > real concerns. Docs weren't buying that. Too rare. About as rare as PA. > > > > > > But I kept pushing so they started chasing a Lupus diagnosis. The ANA was > > > > > > negative and I was pronounced well, except for the psych issues > > > > > > <sigh>. > > > > > > >>> > > > > > > >>>After graduation (1992), I went to work in a > > > > > > community hospital med/surg ICU. At the same time, we moved and began > > > > > > building the `dream house' we could now afford. My four children were > > > > > > struggling to assimilate into a new environment and school. My oldest > > > > > > daughter was living with us with her baby while her husband served in > > > > > > Desert Storm. All four burners were full up and it wasn't long before I > > > > > > began floundering. One night I went to bed. It felt like me HR was about > > > > > > 200 and I could feel the PVCs. Each one made a pronounce thud in my chest > > > > > > followed by a momentary brain haze. It got so intense I finally asked my > > > > > > husband to take me to the ER. My potassium was 2.7. Their treatment of > > > > > > cure was 20mEq of effervescent potassium po and serial labs. I was > > > > > > released when my K+ hit 3.3. I was pronounced well and they sent me on my > > > > > > way. > > > > > > >>> > > > > > > >>>I scheduled an appointment with my doctor who was still not > > > > > > connecting the dots. He did add 20mEq of K+ daily to my meds. Things > > > > > > stayed pretty much the same. On anti-depressants, then off, uncontrolled > > > > > > HTN, micro hematuria, mild proteinuria, panic, anxiety off and on, same > > > > > > stuff that everyone now considered my normal. > > > > > > >>> > > > > > > >>>We built the house, > > > > > > kids were leaving one-by-one and the marriage had run its course. Divorce > > > > > > was inevitable. During this period, I developed `severe' right flank pain. > > > > > > It felt like if I could stick my finger inside my body up to my hand at > > > > > > the level of my inferior rib, I could touch where the pain was located. > > > > > > Now I get it. My doctor gave me some Vicodin which helped but I was > > > > > > miserable, couldn't find a comfortable position and it went on for 2 > > > > > > months. At that time he ordered a CT of my chest. God only knows why. The > > > > > > right adrenal adenoma (or nodule as it was described) was uncovered. Still > > > > > > not connecting the dots, him or me. > > > > > > >>> > > > > > > >>>That year I divorced and > > > > > > relocated to Houston. I was happier and felt healthier. I was even able to > > > > > > wean down my anti-hypertensives. This is when the issues with my back > > > > > > began and the introduction of daily NSAIDs. It is now a concern for me > > > > > > because I know there is an issue with combining NSAIDs and Spiro. Your > > > > > > thoughts? > > > > > > >>> > > > > > > >>>More life changes. I moved back to Chicago October 2004 > > > > > > and decided to give my failed marriage a second chance. It was less > > > > > > stressful than it had been, but still acceptable. Soon, I started having a > > > > > > lot of PVCs again. I was at work one night and decided to run a strip to > > > > > > see if these were PACs of PVCs. They were PVCs (bigeminy, trigeminy, and > > > > > > random). I had a nurse friend draw some blood and we sent it to lab. My > > > > > > potassium was 2.8. I called the pharmacy and they sent me 100 mEq of K+. > > > > > > It suppressed the PVCs for a few days but they returned. Again, I ran a > > > > > > strip, drew blood, K+ was 3.0. Sent for a supplement and went to the > > > > > > clinic. The doctor I had always seen left the Clinic, so I no longer had a > > > > > > doctor. An Immediate Care physician saw me. He ordered a 24-hr Holter and > > > > > > labs. The PVCs were ridiculously high. I know. I could feel every one. But > > > > > > nothing was done. No follow-up, consultations, referrals, or > > > > > > treatment. > > > > > > >>> > > > > > > >>>Things were deteriorating rapidly with the current > > > > > > living situation, so I moved out. I began having severe lower leg and feet > > > > > > cramps in 2008. I also was having frequent lower leg fasciculations, > > > > > > particularly when I'd lay down. I started taking B12 for the cramping > > > > > > which helped quite a bit. In January 2009 I moved to polis, MD to take > > > > > > a job at s Hopkins. A death in the family brought me home again in > > > > > > October 2009. I retired and it's been downhill ever since. > > > > > > >>> > > > > > > >>>Being > > > > > > uninsured until July 2012 (Medicare), I was seeing a NP at a local > > > > > > doc-in-a-box to get my prescriptions. I started having days filled with > > > > > > PVCs and depression. I was started back on Doxepin. Labs showed my > > > > > > potassium to be in the 3.0 to 3.2 range, a level that makes me > > > > > > symptomatic. Knowing the cause, I finally just started treating it myself, > > > > > > usually 80-120mEq over a day and a half and I would be okay for a couple > > > > > > of weeks. It was during this time that it registered how often I was > > > > > > urinating. It was so much that I finally bought a meter to check my BS. It > > > > > > was and is normal as is my A1C. > > > > > > >>> > > > > > > >>>I needed a higher level of care so > > > > > > I started seeing the PA at the doc-in-a-box thinking she would be > > > > > > consulting with the in-house doctor regarding my care. After the initial > > > > > > appointment, I was told they would no longer prescribe the Doxepin. The > > > > > > doctor thought I was taking it for sleep or selling it, not sure which. I > > > > > > also needed medication refills. The potassium called in was ½ my normal > > > > > > dose. I freaked because I was almost out and having PVCs again. So I > > > > > > gathered my history `evidence' and took it to the PA. She refused to > > > > > > prescribe the correct amount after I told her I was self-medicating and > > > > > > why with the proof in hand. After an embarrassing tete tete occurring in > > > > > > front of staff and a waiting room full of patients, I stormed out. I asked > > > > > > a friend pull a few strings (doctors won't see you if you're a self-pay > > > > > > I've discovered) and I got in to see a family practice doc in September > > > > > > 2011. > > > > > > >>> > > > > > > >>>Rather than have a staff member record my history > > > > > > incorrectly, I put it in H & P format and handed it to the doctor. While > > > > > > preparing the document, I decided to do some research on the causes of > > > > > > chronic low potassium other than the obvious (thiazide diuretic, albuterol > > > > > > inhaler, and recent rounds of prednisone for pneumonia). Imagine my > > > > > > surprise when Conn's popped up and I finally connected the dots. I am THE > > > > > > POSTER CHILD for Stage IV Conn's. > > > > > > >>> > > > > > > >>>When I had my appointment with > > > > > > the family practice doc, I said, " The bilateral adrenal adenomas are > > > > > > probably functional and it is highly likely that I have Conn's Syndrome " . > > > > > > I told him about the low potassium, my symptoms, and how I had been > > > > > > treating it. Much to my surprise and without labs to back up my claim, he > > > > > > prescribed K+ supplements equal to my bi-tri-weekly fix. However, no PA > > > > > > blood or urine labs were ordered and his primary concern was the right > > > > > > renal artery stenosis. The way I viewed that: if my aorta showed > > > > > > calcification in 2000, it is highly likely that the renal artery is also > > > > > > calcified. I thought that was probable because I have been mildly > > > > > > hypercalcemic for years. That I attributed to higher blood calcium levels > > > > > > secondary to CCB therapy. Now I am not so sure. > > > > > > >>> > > > > > > >>>I do have a > > > > > > question: In your Evolution article you state that one of the symptoms of > > > > > > the 34-year-old female was a positive Chevostek and Trousseau. Aren't > > > > > > those tests reflective of low blood calcium? Also, my lab abnormalities > > > > > > are often part of the earth metal/alkaline earth metal periodic family. Is > > > > > > there a correlation other than the valence numbers? > > > > > > >>> > > > > > > >>>Also, a few > > > > > > days a month about an hour after I take my meds, I start feeling > > > > > > light-headed and strange. I know now that the feeling is related to > > > > > > bradycardia and hypotension (HR 50's, BP 80's/30-40's). As the half-life > > > > > > decreases the circulating levels, my HR and BP began looking like my > > > > > > baseline (HR 70's, BP 140-150/80-90). When I feel that way, my radial > > > > > > pulse is almost not palpable. Laying down, of course, helps. So, now I am > > > > > > thinking that, on those days, my aldosterone is suppressed. Am I > > > > > > right? > > > > > > >>> > > > > > > >>>Another thing: Around 2003-4 or so, we started using > > > > > > Nesiritide (atrial natriuretic †" ANH stimulator) instead of Dobutrex and > > > > > > Primacor for our CHFers. In the Evolution article, you say that increased > > > > > > vascular pressures promotes natriuresis. So, it follows that these > > > > > > patients have decompensated and no longer respond to the body's > > > > > > compensatory mechanism, correct? Also, does this have something to do with > > > > > > the push for ACE inhibitors as the lead medication in treating > > > > > > HTN? > > > > > > >>> > > > > > > >>>One more question: I am post-menopausal but did have night > > > > > > sweats before menopause that I attributed to hormone levels. I still have > > > > > > night sweats but these are different. I wake up about every two hours. At > > > > > > first I feel almost afraid, my heart starts racing, then I feel completely > > > > > > strange, then I get really hot. The onset of another symptom ends the > > > > > > prior symptom. I've timed it from the fear feeling to the end. It lasts > > > > > > about 4-5 minutes. Then everything returns to normal. This happens most > > > > > > nights sometimes every two hours all night It even happens when I nap. It > > > > > > is what wakes me up. I researched the symptoms and was thinking there was > > > > > > a correlation to LH and FSH based on the q 2 hour cycle. I also considered > > > > > > a release of cortisol. Now I wonder if it is part and parcel of the PA. > > > > > > Any thoughts? Is aldosterone released in intervals? If so, what's the time > > > > > > frame? > > > > > > >>> > > > > > > >>>Finally, of the Stage IV symptoms, these are the ones I've > > > > > > experienced: profound hypokalemia, polyuria, drug resistant HTN, > > > > > > hand/feet/leg cramps, profound weakness, periodic paralysis (onset when I > > > > > > stand but then it subsides in a couple of minutes), arrhythmias, mild > > > > > > proteinuria, and alkaline urine. > > > > > > >>> > > > > > > >>>There is so much more I am > > > > > > probably leaving out, but I am sure you will ask the questions that will > > > > > > free that information. So, thank you for your time and consideration. I'm > > > > > > looking forward to the journey. > > > > > > >>> > > > > > > >>>Barbara Tatro > > > > > > >>> > > > > > > >>>Medical > > > > > > History > > > > > > >>> > > > > > > >>>1. Hypertension †" DX 1989 - age 42 †" Severe and resistant > > > > > > since DX > > > > > > >>>2. Right Renal Artery Stenosis (70%) †" 2009 > > > > > > >>>3. Atrophic > > > > > > right kidney > > > > > > >>>4. Adrenal adenoma †" Left 2.2 x 2.5; Right 2.1 x 1.2 > > > > > > >>>Right diagnosed 2-2000 (1.5); Left diagnosed 6-2009 and increased size > > > > > > of right adenoma (described as adrenal nodules) > > > > > > >>>5. Hypokalemia > > > > > > (profound †" 1st incidence 1991, documented 2008-2011) > > > > > > >>>6. Mild > > > > > > hypercalcemia > > > > > > >>>7. Hypomagnesemia > > > > > > >>>8. Micro hematuria (small) > > > > > > >>>9. > > > > > > Mild proteinuria > > > > > > >>>10. Aortic calcification > > > > > > >>>11. Heat > > > > > > Intolerance > > > > > > >>>12. Back †" T11-12 Central disc extrusion, mild central > > > > > > canal stenosis; L1-2 bulging disc with compression of thecal sac; L2-3 > > > > > > bulging disc compressing thecal sac; L3-4 bulging disc, retroliathesis, > > > > > > central canal stenosis biforaminal stenosis; L4-5 unroofed disc, > > > > > > spondyloliatheses, severe central canal and biforaminal stenosis; L5-S1 > > > > > > extruded disc, left and right foraminal stenosis > > > > > > >>>13. Left hip †" joint > > > > > > space narrowing and arthritic changes, subchondral sclerosis (rheumatoid > > > > > > v. osteoarthritis) > > > > > > >>>14. Left lateral leg neuropathy with atrophy > > > > > > >>>15. > > > > > > Falling > > > > > > >>>16. Pneumonia †" February, May, September 2011 > > > > > > >>>17. Bilateral > > > > > > otitis media †" February, May, September 2011 > > > > > > >>>18. COPD > > > > > > >>>19. HPV > > > > > > >>>20. > > > > > > GI bleed †" Diffuse gastritis †" 2002 secondary to NSAID therapy > > > > > > >>>21. > > > > > > Fuch's Corneal Dystrophy (left eye severe, right eye mild to > > > > > > moderate) > > > > > > >>>22. Basal cell carcinoma left cheek > > > > > > >>>23. Adenomyosis †" > > > > > > D & C x 3 1970's > > > > > > >>>24. Fractures †" right tibia, left thumb, spiral > > > > > > fracture right 4th toe > > > > > > >>>25. Seasonal allergies > > > > > > >>>26. Chronic > > > > > > pain > > > > > > >>>27. Depression, anxiety and panic attacks, `nervous breakdown' x3 > > > > > > †" first at age 19 †" about every 10 years thereafter †" last one 1985 > > > > > > >>>28. > > > > > > Severe childhood abuse and molestation > > > > > > >>>29. Smoker 1ppd x 40 > > > > > > years > > > > > > >>> > > > > > > >>>Surgeries > > > > > > >>>1. Exploratory lap, choleycystectomy - > > > > > > 1977 > > > > > > >>>2. Hysteroscopy †" 1995 > > > > > > >>>3. Removal basal cell carcinoma left > > > > > > cheek †" 2000 > > > > > > >>> > > > > > > >>>Family History > > > > > > >>>1. Father (deceased) †" CHF, multiple > > > > > > MI, multiple CVA, Resistant HTN, Fuch's Corneal Dystrophy, depression, > > > > > > HOH > > > > > > >>>2. Mother (deceased) †" HTN, cervical cancer, metastatic cancer > > > > > > >>>3. Sister (68) †" Fuch's corneal dystrophy, depression > > > > > > >>>4. Brother > > > > > > (66) †" Bladder cancer, thyroid cancer, HTN, Type II Diabetes, > > > > > > depression > > > > > > >>>5. Brother (60) †" HTN, Depression, dysrhythmia > > > > > > >>>6. Brother > > > > > > (46) - Dysrhythmia, depression > > > > > > >>> > > > > > > >>>Allergies > > > > > > >>>1. Serotonin †" Seizure, > > > > > > anaphylaxis, Serotonin Syndrome (ER x3) > > > > > > >>>2. Levaquin †" Levaquin > > > > > > Syndrome > > > > > > >>>3. Wellbutrin †" Cardiac dysrhythmia > > > > > > >>> > > > > > > >>>Prevention > > > > > > >>>1. > > > > > > Flu vaccine 11/2012 > > > > > > >>>2. Pneumonia vaccine 11/2010 > > > > > > >>> > > > > > > >>>Medications > > > > > > December - 2011 > > > > > > >>> > > > > > > >>>1. Lisinopril-Hctz 20/12.5 mg BID > > > > > > >>>2. Verapamil > > > > > > 120mg BID > > > > > > >>>3. Labetalol 200mg BID > > > > > > >>>4. Pravastatin 20mg Q night > > > > > > >>>5. > > > > > > Doxepin 75mg QD > > > > > > >>>6. ASA 81mg BID > > > > > > >>>7. Potassium 20 mEq BID > > > > > > >>>8. > > > > > > Doxepin 75 mg QD > > > > > > >>>9. Ibuprofen 800mg BID > > > > > > >>>10. Zyrtec 10 mg QD > > > > > > >>>11. > > > > > > Glucosam/Chon 1500/1200mg QD > > > > > > >>>12. Vit B12 1000mcg QD > > > > > > >>>13. Vit C 500mg > > > > > > QD > > > > > > >>>14. Magnesium 250mg BID > > > > > > >>>15. Multi-Vit 1 tab QD > > > > > > >>>16. Fish Oil > > > > > > 1000 mg BID > > > > > > >>>17. Ventolin Inhale 1-2 puffs PRN > > > > > > >>>18. Naproxen 440mg > > > > > > PRN > > > > > > >>> > > > > > > >>> > > > > > > >> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 15, 2012 Report Share Posted January 15, 2012 Then u are eating too much salt. Also does not cause problems uses u eat too much salt. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Jan 14, 2012, at 12:33, maggiekat7 <ljurkovic@...> wrote: My husband and I have been on the DASH diet since 2007 after his MI. We were given the literature at some point and it worked for him; he's still alive. For me, I have never tolerated salt, so it wasn't that big of a change; raised vegetarian, now more vegan, but I mostly had to make sure my carbs and protien were matched and that helped me lose the weight I needed to lose. Never had issues with BP until a few months ago, haven't changed the diet or exercise, just got high bp out of the blue and low potassium out of the blue. > >> > >> > >>>Dear Dr. Grim, > >>> > >>>I am a 64-year-old female. I am a retired > surgical heart ICU CCRN. I returned to college at age 39, and obtained a > BSN. I also student taught A & P and Micro labs for 12 years > post-graduation at Indiana University NW. I relocated to Houston, TX in > 2001. During my nursing tenure, I worked in community hospitals and for > several prestigious institutions including Methodist Hospital, Texas > Medical Center, Houston, for and with DeBakey. I also worked for > Hazim Safi's AAA unit at Memorial Hermann while in Houston. I have > presented at several critical care consortiums and served as clinical > educator at many of the facilities where I worked. > >>> > >>>So… looking > back on this medical journey confounds me. I, of all people, should have > done the research and found the answer. I attribute part of this > phenomenon to the lack of computer skills. I bought my first computer in > 2000. I wasn't what I would consider `computer literate' for a few more > years. By this time, I was easily 15 years into my PA odyssey and > convinced by professionals I trusted that my right adenoma was just an > `incidental' finding and quite common. I pride myself in my knowledge base > and assessment skills, but I very clearly dropped the ball when it came to > me. > >>> > >>>I do not hold contempt for the doctors who led me astray. If I > couldn't see the writing on the wall, why should they. I will say this, in > 20+ years of critical care nursing I never once cared for a patient with > PA as a primary or secondary diagnosis and I rarely cared for a patient > whose home medications included Spironolactone. Fewer still were > prescribed Spiro during their hospitalization. > >>> > >>>The beginning of > the end: I was diagnosed with HTN during a routine screening to begin my > nursing clinicals (age 42). The person who diagnosed it was an itty bitty > nun who was about 104. Poor thing could barely inflate the cuff. Her first > reading: 170/104. I assumed the extended inflation time had something to > do with it and asked that she repeat it. She did. No change. The doctor > that followed confirmed the DX. Begin the litany of BP meds dispensed so > conservatively, I am surprised I didn't stroke while waiting. Every change > that was made required a waiting period and another visit. Finally, a few > years in, I showed some progress. BPs were generally 140-150's/80-90's and > that was on a good day. The doc took the standard approach: started with a > diuretic then added a CCB, ACE, and finally a b-blocker. See attachment > for current medications. The b-blocker was Labetalol. When this was added > (due to the alpha blocking), I completely stopped have the adrenalin > rushes I had for years â€" so the offender was nor-epi and not epi? But this > created an anti-depressant dilemma: block it with one med, then hold it in > the synapse with another… hmmmm… the old come here, go away therapy. Any > suggestions because I am on both currently? > >>> > >>>From age 19 until my > diagnosis and treatment for clinical depression in 1985, I had repeated > episodes of depression, anxiety attacks, panic attacks, even agoraphobia. > When I was finally diagnosed, I was put on Doxepin and have taken it > intermittently since that time. My history includes severe child abuse and > molestation. So what do I do after I escaped? I, in essence, married my > father and the abuse and stress continued. I just kept throwing more logs > on the fire. I therefore attributed much of what I was experiencing to my > history. I assumed my resistant pressures were anxiety-driven. During this > time, I could feel the release of adrenalin. It hit my chest like > 360joules. Then the panic and anxiety would ensue. After reading The > Evolution, I see that psycho-social stress can produce adenomas. Huge > ah-ha moment for this critical care RN. > >>> > >>>During this time, I > suggested a possible pheochromocytoma diagnosis. With the uncontrollable > HTN and added microhematuria and mild proteinuria I was beginning to have > real concerns. Docs weren't buying that. Too rare. About as rare as PA. > But I kept pushing so they started chasing a Lupus diagnosis. The ANA was > negative and I was pronounced well, except for the psych issues > <sigh>. > >>> > >>>After graduation (1992), I went to work in a > community hospital med/surg ICU. At the same time, we moved and began > building the `dream house' we could now afford. My four children were > struggling to assimilate into a new environment and school. My oldest > daughter was living with us with her baby while her husband served in > Desert Storm. All four burners were full up and it wasn't long before I > began floundering. One night I went to bed. It felt like me HR was about > 200 and I could feel the PVCs. Each one made a pronounce thud in my chest > followed by a momentary brain haze. It got so intense I finally asked my > husband to take me to the ER. My potassium was 2.7. Their treatment of > cure was 20mEq of effervescent potassium po and serial labs. I was > released when my K+ hit 3.3. I was pronounced well and they sent me on my > way. > >>> > >>>I scheduled an appointment with my doctor who was still not > connecting the dots. He did add 20mEq of K+ daily to my meds. Things > stayed pretty much the same. On anti-depressants, then off, uncontrolled > HTN, micro hematuria, mild proteinuria, panic, anxiety off and on, same > stuff that everyone now considered my normal. > >>> > >>>We built the house, > kids were leaving one-by-one and the marriage had run its course. Divorce > was inevitable. During this period, I developed `severe' right flank pain. > It felt like if I could stick my finger inside my body up to my hand at > the level of my inferior rib, I could touch where the pain was located. > Now I get it. My doctor gave me some Vicodin which helped but I was > miserable, couldn't find a comfortable position and it went on for 2 > months. At that time he ordered a CT of my chest. God only knows why. The > right adrenal adenoma (or nodule as it was described) was uncovered. Still > not connecting the dots, him or me. > >>> > >>>That year I divorced and > relocated to Houston. I was happier and felt healthier. I was even able to > wean down my anti-hypertensives. This is when the issues with my back > began and the introduction of daily NSAIDs. It is now a concern for me > because I know there is an issue with combining NSAIDs and Spiro. Your > thoughts? > >>> > >>>More life changes. I moved back to Chicago October 2004 > and decided to give my failed marriage a second chance. It was less > stressful than it had been, but still acceptable. Soon, I started having a > lot of PVCs again. I was at work one night and decided to run a strip to > see if these were PACs of PVCs. They were PVCs (bigeminy, trigeminy, and > random). I had a nurse friend draw some blood and we sent it to lab. My > potassium was 2.8. I called the pharmacy and they sent me 100 mEq of K+. > It suppressed the PVCs for a few days but they returned. Again, I ran a > strip, drew blood, K+ was 3.0. Sent for a supplement and went to the > clinic. The doctor I had always seen left the Clinic, so I no longer had a > doctor. An Immediate Care physician saw me. He ordered a 24-hr Holter and > labs. The PVCs were ridiculously high. I know. I could feel every one. But > nothing was done. No follow-up, consultations, referrals, or > treatment. > >>> > >>>Things were deteriorating rapidly with the current > living situation, so I moved out. I began having severe lower leg and feet > cramps in 2008. I also was having frequent lower leg fasciculations, > particularly when I'd lay down. I started taking B12 for the cramping > which helped quite a bit. In January 2009 I moved to polis, MD to take > a job at s Hopkins. A death in the family brought me home again in > October 2009. I retired and it's been downhill ever since. > >>> > >>>Being > uninsured until July 2012 (Medicare), I was seeing a NP at a local > doc-in-a-box to get my prescriptions. I started having days filled with > PVCs and depression. I was started back on Doxepin. Labs showed my > potassium to be in the 3.0 to 3.2 range, a level that makes me > symptomatic. Knowing the cause, I finally just started treating it myself, > usually 80-120mEq over a day and a half and I would be okay for a couple > of weeks. It was during this time that it registered how often I was > urinating. It was so much that I finally bought a meter to check my BS. It > was and is normal as is my A1C. > >>> > >>>I needed a higher level of care so > I started seeing the PA at the doc-in-a-box thinking she would be > consulting with the in-house doctor regarding my care. After the initial > appointment, I was told they would no longer prescribe the Doxepin. The > doctor thought I was taking it for sleep or selling it, not sure which. I > also needed medication refills. The potassium called in was ½ my normal > dose. I freaked because I was almost out and having PVCs again. So I > gathered my history `evidence' and took it to the PA. She refused to > prescribe the correct amount after I told her I was self-medicating and > why with the proof in hand. After an embarrassing tete tete occurring in > front of staff and a waiting room full of patients, I stormed out. I asked > a friend pull a few strings (doctors won't see you if you're a self-pay > I've discovered) and I got in to see a family practice doc in September > 2011. > >>> > >>>Rather than have a staff member record my history > incorrectly, I put it in H & P format and handed it to the doctor. While > preparing the document, I decided to do some research on the causes of > chronic low potassium other than the obvious (thiazide diuretic, albuterol > inhaler, and recent rounds of prednisone for pneumonia). Imagine my > surprise when Conn's popped up and I finally connected the dots. I am THE > POSTER CHILD for Stage IV Conn's. > >>> > >>>When I had my appointment with > the family practice doc, I said, "The bilateral adrenal adenomas are > probably functional and it is highly likely that I have Conn's Syndrome". > I told him about the low potassium, my symptoms, and how I had been > treating it. Much to my surprise and without labs to back up my claim, he > prescribed K+ supplements equal to my bi-tri-weekly fix. However, no PA > blood or urine labs were ordered and his primary concern was the right > renal artery stenosis. The way I viewed that: if my aorta showed > calcification in 2000, it is highly likely that the renal artery is also > calcified. I thought that was probable because I have been mildly > hypercalcemic for years. That I attributed to higher blood calcium levels > secondary to CCB therapy. Now I am not so sure. > >>> > >>>I do have a > question: In your Evolution article you state that one of the symptoms of > the 34-year-old female was a positive Chevostek and Trousseau. Aren't > those tests reflective of low blood calcium? Also, my lab abnormalities > are often part of the earth metal/alkaline earth metal periodic family. Is > there a correlation other than the valence numbers? > >>> > >>>Also, a few > days a month about an hour after I take my meds, I start feeling > light-headed and strange. I know now that the feeling is related to > bradycardia and hypotension (HR 50's, BP 80's/30-40's). As the half-life > decreases the circulating levels, my HR and BP began looking like my > baseline (HR 70's, BP 140-150/80-90). When I feel that way, my radial > pulse is almost not palpable. Laying down, of course, helps. So, now I am > thinking that, on those days, my aldosterone is suppressed. Am I > right? > >>> > >>>Another thing: Around 2003-4 or so, we started using > Nesiritide (atrial natriuretic â€" ANH stimulator) instead of Dobutrex and > Primacor for our CHFers. In the Evolution article, you say that increased > vascular pressures promotes natriuresis. So, it follows that these > patients have decompensated and no longer respond to the body's > compensatory mechanism, correct? Also, does this have something to do with > the push for ACE inhibitors as the lead medication in treating > HTN? > >>> > >>>One more question: I am post-menopausal but did have night > sweats before menopause that I attributed to hormone levels. I still have > night sweats but these are different. I wake up about every two hours. At > first I feel almost afraid, my heart starts racing, then I feel completely > strange, then I get really hot. The onset of another symptom ends the > prior symptom. I've timed it from the fear feeling to the end. It lasts > about 4-5 minutes. Then everything returns to normal. This happens most > nights sometimes every two hours all night It even happens when I nap. It > is what wakes me up. I researched the symptoms and was thinking there was > a correlation to LH and FSH based on the q 2 hour cycle. I also considered > a release of cortisol. Now I wonder if it is part and parcel of the PA. > Any thoughts? Is aldosterone released in intervals? If so, what's the time > frame? > >>> > >>>Finally, of the Stage IV symptoms, these are the ones I've > experienced: profound hypokalemia, polyuria, drug resistant HTN, > hand/feet/leg cramps, profound weakness, periodic paralysis (onset when I > stand but then it subsides in a couple of minutes), arrhythmias, mild > proteinuria, and alkaline urine. > >>> > >>>There is so much more I am > probably leaving out, but I am sure you will ask the questions that will > free that information. So, thank you for your time and consideration. I'm > looking forward to the journey. > >>> > >>>Barbara Tatro > >>> > >>>Medical > History > >>> > >>>1. Hypertension â€" DX 1989 - age 42 â€" Severe and resistant > since DX > >>>2. Right Renal Artery Stenosis (70%) â€" 2009 > >>>3. Atrophic > right kidney > >>>4. Adrenal adenoma â€" Left 2.2 x 2.5; Right 2.1 x 1.2 > >>>Right diagnosed 2-2000 (1.5); Left diagnosed 6-2009 and increased size > of right adenoma (described as adrenal nodules) > >>>5. Hypokalemia > (profound â€" 1st incidence 1991, documented 2008-2011) > >>>6. Mild > hypercalcemia > >>>7. Hypomagnesemia > >>>8. Micro hematuria (small) > >>>9. > Mild proteinuria > >>>10. Aortic calcification > >>>11. Heat > Intolerance > >>>12. Back â€" T11-12 Central disc extrusion, mild central > canal stenosis; L1-2 bulging disc with compression of thecal sac; L2-3 > bulging disc compressing thecal sac; L3-4 bulging disc, retroliathesis, > central canal stenosis biforaminal stenosis; L4-5 unroofed disc, > spondyloliatheses, severe central canal and biforaminal stenosis; L5-S1 > extruded disc, left and right foraminal stenosis > >>>13. Left hip â€" joint > space narrowing and arthritic changes, subchondral sclerosis (rheumatoid > v. osteoarthritis) > >>>14. Left lateral leg neuropathy with atrophy > >>>15. > Falling > >>>16. Pneumonia â€" February, May, September 2011 > >>>17. Bilateral > otitis media â€" February, May, September 2011 > >>>18. COPD > >>>19. HPV > >>>20. > GI bleed â€" Diffuse gastritis â€" 2002 secondary to NSAID therapy > >>>21. > Fuch's Corneal Dystrophy (left eye severe, right eye mild to > moderate) > >>>22. Basal cell carcinoma left cheek > >>>23. Adenomyosis â€" > D & C x 3 1970's > >>>24. Fractures â€" right tibia, left thumb, spiral > fracture right 4th toe > >>>25. Seasonal allergies > >>>26. Chronic > pain > >>>27. Depression, anxiety and panic attacks, `nervous breakdown' x3 > â€" first at age 19 â€" about every 10 years thereafter â€" last one 1985 > >>>28. > Severe childhood abuse and molestation > >>>29. Smoker 1ppd x 40 > years > >>> > >>>Surgeries > >>>1. Exploratory lap, choleycystectomy - > 1977 > >>>2. Hysteroscopy â€" 1995 > >>>3. Removal basal cell carcinoma left > cheek â€" 2000 > >>> > >>>Family History > >>>1. Father (deceased) â€" CHF, multiple > MI, multiple CVA, Resistant HTN, Fuch's Corneal Dystrophy, depression, > HOH > >>>2. Mother (deceased) â€" HTN, cervical cancer, metastatic cancer > >>>3. Sister (68) â€" Fuch's corneal dystrophy, depression > >>>4. Brother > (66) â€" Bladder cancer, thyroid cancer, HTN, Type II Diabetes, > depression > >>>5. Brother (60) â€" HTN, Depression, dysrhythmia > >>>6. Brother > (46) - Dysrhythmia, depression > >>> > >>>Allergies > >>>1. Serotonin â€" Seizure, > anaphylaxis, Serotonin Syndrome (ER x3) > >>>2. Levaquin â€" Levaquin > Syndrome > >>>3. Wellbutrin â€" Cardiac dysrhythmia > >>> > >>>Prevention > >>>1. > Flu vaccine 11/2012 > >>>2. Pneumonia vaccine 11/2010 > >>> > >>>Medications > December - 2011 > >>> > >>>1. Lisinopril-Hctz 20/12.5 mg BID > >>>2. Verapamil > 120mg BID > >>>3. Labetalol 200mg BID > >>>4. Pravastatin 20mg Q night > >>>5. > Doxepin 75mg QD > >>>6. ASA 81mg BID > >>>7. Potassium 20 mEq BID > >>>8. > Doxepin 75 mg QD > >>>9. Ibuprofen 800mg BID > >>>10. Zyrtec 10 mg QD > >>>11. > Glucosam/Chon 1500/1200mg QD > >>>12. Vit B12 1000mcg QD > >>>13. Vit C 500mg > QD > >>>14. Magnesium 250mg BID > >>>15. Multi-Vit 1 tab QD > >>>16. Fish Oil > 1000 mg BID > >>>17. Ventolin Inhale 1-2 puffs PRN > >>>18. Naproxen 440mg > PRN > >>> > >>> > >> > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 15, 2012 Report Share Posted January 15, 2012 U want more K than Na in the urine and the 24 hr Na to be less than 67 mM and K more than 115/24 hr. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Jan 14, 2012, at 21:29, maggiekat7 <ljurkovic@...> wrote: Did a 24 hour urine test, dropped it off friday. Waiting to hear results...what values do I look for to see if I am DASHING well enough? Is that the urine test or another? > > > >> > > > >> > > > >>>Dear Dr. Grim, > > > >>> > > > >>>I am a 64-year-old female. I am a retired > > > surgical heart ICU CCRN. I returned to college at age 39, and obtained a > > > BSN. I also student taught A & P and Micro labs for 12 years > > > post-graduation at Indiana University NW. I relocated to Houston, TX in > > > 2001. During my nursing tenure, I worked in community hospitals and for > > > several prestigious institutions including Methodist Hospital, Texas > > > Medical Center, Houston, for and with DeBakey. I also worked for > > > Hazim Safi's AAA unit at Memorial Hermann while in Houston. I have > > > presented at several critical care consortiums and served as clinical > > > educator at many of the facilities where I worked. > > > >>> > > > >>>So… looking > > > back on this medical journey confounds me. I, of all people, should have > > > done the research and found the answer. I attribute part of this > > > phenomenon to the lack of computer skills. I bought my first computer in > > > 2000. I wasn't what I would consider `computer literate' for a few more > > > years. By this time, I was easily 15 years into my PA odyssey and > > > convinced by professionals I trusted that my right adenoma was just an > > > `incidental' finding and quite common. I pride myself in my knowledge base > > > and assessment skills, but I very clearly dropped the ball when it came to > > > me. > > > >>> > > > >>>I do not hold contempt for the doctors who led me astray. If I > > > couldn't see the writing on the wall, why should they. I will say this, in > > > 20+ years of critical care nursing I never once cared for a patient with > > > PA as a primary or secondary diagnosis and I rarely cared for a patient > > > whose home medications included Spironolactone. Fewer still were > > > prescribed Spiro during their hospitalization. > > > >>> > > > >>>The beginning of > > > the end: I was diagnosed with HTN during a routine screening to begin my > > > nursing clinicals (age 42). The person who diagnosed it was an itty bitty > > > nun who was about 104. Poor thing could barely inflate the cuff. Her first > > > reading: 170/104. I assumed the extended inflation time had something to > > > do with it and asked that she repeat it. She did. No change. The doctor > > > that followed confirmed the DX. Begin the litany of BP meds dispensed so > > > conservatively, I am surprised I didn't stroke while waiting. Every change > > > that was made required a waiting period and another visit. Finally, a few > > > years in, I showed some progress. BPs were generally 140-150's/80-90's and > > > that was on a good day. The doc took the standard approach: started with a > > > diuretic then added a CCB, ACE, and finally a b-blocker. See attachment > > > for current medications. The b-blocker was Labetalol. When this was added > > > (due to the alpha blocking), I completely stopped have the adrenalin > > > rushes I had for years â€" so the offender was nor-epi and not epi? But this > > > created an anti-depressant dilemma: block it with one med, then hold it in > > > the synapse with another… hmmmm… the old come here, go away therapy. Any > > > suggestions because I am on both currently? > > > >>> > > > >>>From age 19 until my > > > diagnosis and treatment for clinical depression in 1985, I had repeated > > > episodes of depression, anxiety attacks, panic attacks, even agoraphobia. > > > When I was finally diagnosed, I was put on Doxepin and have taken it > > > intermittently since that time. My history includes severe child abuse and > > > molestation. So what do I do after I escaped? I, in essence, married my > > > father and the abuse and stress continued. I just kept throwing more logs > > > on the fire. I therefore attributed much of what I was experiencing to my > > > history. I assumed my resistant pressures were anxiety-driven. During this > > > time, I could feel the release of adrenalin. It hit my chest like > > > 360joules. Then the panic and anxiety would ensue. After reading The > > > Evolution, I see that psycho-social stress can produce adenomas. Huge > > > ah-ha moment for this critical care RN. > > > >>> > > > >>>During this time, I > > > suggested a possible pheochromocytoma diagnosis. With the uncontrollable > > > HTN and added microhematuria and mild proteinuria I was beginning to have > > > real concerns. Docs weren't buying that. Too rare. About as rare as PA. > > > But I kept pushing so they started chasing a Lupus diagnosis. The ANA was > > > negative and I was pronounced well, except for the psych issues > > > <sigh>. > > > >>> > > > >>>After graduation (1992), I went to work in a > > > community hospital med/surg ICU. At the same time, we moved and began > > > building the `dream house' we could now afford. My four children were > > > struggling to assimilate into a new environment and school. My oldest > > > daughter was living with us with her baby while her husband served in > > > Desert Storm. All four burners were full up and it wasn't long before I > > > began floundering. One night I went to bed. It felt like me HR was about > > > 200 and I could feel the PVCs. Each one made a pronounce thud in my chest > > > followed by a momentary brain haze. It got so intense I finally asked my > > > husband to take me to the ER. My potassium was 2.7. Their treatment of > > > cure was 20mEq of effervescent potassium p Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 15, 2012 Report Share Posted January 15, 2012 Hope they did a u Na and K as cannot interpret also without that. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Jan 14, 2012, at 21:58, maggiekat7 <ljurkovic@...> wrote: no water softener, we use a Brita water filtering system. What values of sodium and k am I looking for? They are testing for adolsterone, meta something, and catacholamine, as well as a micro somthing panel. > > > > > >> > > > > > >> > > > > > >>>Dear Dr. Grim, > > > > > >>> > > > > > >>>I am a 64-year-old female. I am a retired > > > > > surgical heart ICU CCRN. I returned to college at age 39, and obtained a > > > > > BSN. I also student taught A & P and Micro labs for 12 years > > > > > post-graduation at Indiana University NW. I relocated to Houston, TX in > > > > > 2001. During my nursing tenure, I worked in community hospitals and for > > > > > several prestigious institutions including Methodist Hospital, Texas > > > > > Medical Center, Houston, for and with DeBakey. I also worked for > > > > > Hazim Safi's AAA unit at Memorial Hermann while in Houston. I have > > > > > presented at several critical care consortiums and served as clinical > > > > > educator at many of the facilities where I worked. > > > > > >>> > > > > > >>>So… looking > > > > > back on this medical journey confounds me. I, of all people, should have > > > > > done the research and found the answer. I attribute part of this > > > > > phenomenon to the lack of computer skills. I bought my first computer in > > > > > 2000. I wasn't what I would consider `computer literate' for a few more > > > > > years. By this time, I was easily 15 years into my PA odyssey and > > > > > convinced by professionals I trusted that my right adenoma was just an > > > > > `incidental' finding and quite common. I pride myself in my knowledge base > > > > > and assessment skills, but I very clearly dropped the ball when it came to > > > > > me. > > > > > >>> > > > > > >>>I do not hold contempt for the doctors who led me astray. If I > > > > > couldn't see the writing on the wall, why should they. I will say this, in > > > > > 20+ years of critical care nursing I never once cared for a patient with > > > > > PA as a primary or secondary diagnosis and I rarely cared for a patient > > > > > whose home medications included Spironolactone. Fewer still were > > > > > prescribed Spiro during their hospitalization. > > > > > >>> > > > > > >>>The beginning of > > > > > the end: I was diagnosed with HTN during a routine screening to begin my > > > > > nursing clinicals (age 42). The person who diagnosed it was an itty bitty > > > > > nun who was about 104. Poor thing could barely inflate the cuff. Her first > > > > > reading: 170/104. I assumed the extended inflation time had something to > > > > > do with it and asked that she repeat it. She did. No change. The doctor > > > > > that followed confirmed the DX. Begin the litany of BP meds dispensed so > > > > > conservatively, I am surprised I didn't stroke while waiting. Every change > > > > > that was made required a waiting period and another visit. Finally, a few > > > > > years in, I showed some progress. BPs were generally 140-150's/80-90's and > > > > > that was on a good day. The doc took the standard approach: started with a > > > > > diuretic then added a CCB, ACE, and finally a b-blocker. See attachment > > > > > for current medications. The b-blocker was Labetalol. When this was added > > > > > (due to the alpha blocking), I completely stopped have the adrenalin > > > > > rushes I had for years â€" so the offender was nor-epi and not epi? But this > > > > > created an anti-depressant dilemma: block it with one med, then hold it in > > > > > the synapse with another… hmmmm… the old come here, go away therapy. Any > > > > > suggestions because I am on both currently? > > > > > >>> > > > > > >>>From age 19 until my > > > > > diagnosis and treatment for clinical depression in 1985, I had repeated > > > > > episodes of depression, anxiety attacks, panic attacks, even agoraphobia. > > > > > When I was finally diagnosed, I was put on Doxepin and have taken Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 15, 2012 Report Share Posted January 15, 2012 Hope they did a u Na and K as cannot interpret also without that. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Jan 14, 2012, at 21:58, maggiekat7 <ljurkovic@...> wrote: no water softener, we use a Brita water filtering system. What values of sodium and k am I looking for? They are testing for adolsterone, meta something, and catacholamine, as well as a micro somthing panel. > > > > > >> > > > > > >> > > > > > >>>Dear Dr. Grim, > > > > > >>> > > > > > >>>I am a 64-year-old female. I am a retired > > > > > surgical heart ICU CCRN. I returned to college at age 39, and obtained a > > > > > BSN. I also student taught A & P and Micro labs for 12 years > > > > > post-graduation at Indiana University NW. I relocated to Houston, TX in > > > > > 2001. During my nursing tenure, I worked in community hospitals and for > > > > > several prestigious institutions including Methodist Hospital, Texas > > > > > Medical Center, Houston, for and with DeBakey. I also worked for > > > > > Hazim Safi's AAA unit at Memorial Hermann while in Houston. I have > > > > > presented at several critical care consortiums and served as clinical > > > > > educator at many of the facilities where I worked. > > > > > >>> > > > > > >>>So… looking > > > > > back on this medical journey confounds me. I, of all people, should have > > > > > done the research and found the answer. I attribute part of this > > > > > phenomenon to the lack of computer skills. I bought my first computer in > > > > > 2000. I wasn't what I would consider `computer literate' for a few more > > > > > years. By this time, I was easily 15 years into my PA odyssey and > > > > > convinced by professionals I trusted that my right adenoma was just an > > > > > `incidental' finding and quite common. I pride myself in my knowledge base > > > > > and assessment skills, but I very clearly dropped the ball when it came to > > > > > me. > > > > > >>> > > > > > >>>I do not hold contempt for the doctors who led me astray. If I > > > > > couldn't see the writing on the wall, why should they. I will say this, in > > > > > 20+ years of critical care nursing I never once cared for a patient with > > > > > PA as a primary or secondary diagnosis and I rarely cared for a patient > > > > > whose home medications included Spironolactone. Fewer still were > > > > > prescribed Spiro during their hospitalization. > > > > > >>> > > > > > >>>The beginning of > > > > > the end: I was diagnosed with HTN during a routine screening to begin my > > > > > nursing clinicals (age 42). The person who diagnosed it was an itty bitty > > > > > nun who was about 104. Poor thing could barely inflate the cuff. Her first > > > > > reading: 170/104. I assumed the extended inflation time had something to > > > > > do with it and asked that she repeat it. She did. No change. The doctor > > > > > that followed confirmed the DX. Begin the litany of BP meds dispensed so > > > > > conservatively, I am surprised I didn't stroke while waiting. Every change > > > > > that was made required a waiting period and another visit. Finally, a few > > > > > years in, I showed some progress. BPs were generally 140-150's/80-90's and > > > > > that was on a good day. The doc took the standard approach: started with a > > > > > diuretic then added a CCB, ACE, and finally a b-blocker. See attachment > > > > > for current medications. The b-blocker was Labetalol. When this was added > > > > > (due to the alpha blocking), I completely stopped have the adrenalin > > > > > rushes I had for years â€" so the offender was nor-epi and not epi? But this > > > > > created an anti-depressant dilemma: block it with one med, then hold it in > > > > > the synapse with another… hmmmm… the old come here, go away therapy. Any > > > > > suggestions because I am on both currently? > > > > > >>> > > > > > >>>From age 19 until my > > > > > diagnosis and treatment for clinical depression in 1985, I had repeated > > > > > episodes of depression, anxiety attacks, panic attacks, even agoraphobia. > > > > > When I was finally diagnosed, I was put on Doxepin and have taken Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 15, 2012 Report Share Posted January 15, 2012 What do you mean. Ever tolerated salt?May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Jan 14, 2012, at 12:33, maggiekat7 <ljurkovic@...> wrote: My husband and I have been on the DASH diet since 2007 after his MI. We were given the literature at some point and it worked for him; he's still alive. For me, I have never tolerated salt, so it wasn't that big of a change; raised vegetarian, now more vegan, but I mostly had to make sure my carbs and protien were matched and that helped me lose the weight I needed to lose. Never had issues with BP until a few months ago, haven't changed the diet or exercise, just got high bp out of the blue and low potassium out of the blue. > >> > >> > >>>Dear Dr. Grim, > >>> > >>>I am a 64-year-old female. I am a retired > surgical heart ICU CCRN. I returned to college at age 39, and obtained a > BSN. I also student taught A & P and Micro labs for 12 years > post-graduation at Indiana University NW. I relocated to Houston, TX in > 2001. During my nursing tenure, I worked in community hospitals and for > several prestigious institutions including Methodist Hospital, Texas > Medical Center, Houston, for and with DeBakey. I also worked for > Hazim Safi's AAA unit at Memorial Hermann while in Houston. I have > presented at several critical care consortiums and served as clinical > educator at many of the facilities where I worked. > >>> > >>>So… looking > back on this medical journey confounds me. I, of all people, should have > done the research and found the answer. I attribute part of this > phenomenon to the lack of computer skills. I bought my first computer in > 2000. I wasn't what I would consider `computer literate' for a few more > years. By this time, I was easily 15 years into my PA odyssey and > convinced by professionals I trusted that my right adenoma was just an > `incidental' finding and quite common. I pride myself in my knowledge base > and assessment skills, but I very clearly dropped the ball when it came to > me. > >>> > >>>I do not hold contempt for the doctors who led me astray. If I > couldn't see the writing on the wall, why should they. I will say this, in > 20+ years of critical care nursing I never once cared for a patient with > PA as a primary or secondary diagnosis and I rarely cared for a patient > whose home medications included Spironolactone. Fewer still were > prescribed Spiro during their hospitalization. > >>> > >>>The beginning of > the end: I was diagnosed with HTN during a routine screening to begin my > nursing clinicals (age 42). The person who diagnosed it was an itty bitty > nun who was about 104. Poor thing could barely inflate the cuff. Her first > reading: 170/104. I assumed the extended inflation time had something to > do with it and asked that she repeat it. She did. No change. The doctor > that followed confirmed the DX. Begin the litany of BP meds dispensed so > conservatively, I am surprised I didn't stroke while waiting. Every change > that was made required a waiting period and another visit. Finally, a few > years in, I showed some progress. BPs were generally 140-150's/80-90's and > that was on a good day. The doc took the standard approach: started with a > diuretic then added a CCB, ACE, and finally a b-blocker. See attachment > for current medications. The b-blocker was Labetalol. When this was added > (due to the alpha blocking), I completely stopped have the adrenalin > rushes I had for years â€" so the offender was nor-epi and not epi? But this > created an anti-depressant dilemma: block it with one med, then hold it in > the synapse with another… hmmmm… the old come here, go away therapy. Any > suggestions because I am on both currently? > >>> > >>>From age 19 until my > diagnosis and treatment for clinical depression in 1985, I had repeated > episodes of depression, anxiety attacks, panic attacks, even agoraphobia. > When I was finally diagnosed, I was put on Doxepin and have taken it > intermittently since that time. My history includes severe child abuse and > molestation. So what do I do after I escaped? I, in essence, married my > father and the abuse and stress continued. I just kept throwing more logs > on the fire. I therefore attributed much of what I was experiencing to my > history. I assumed my resistant pressures were anxiety-driven. During this > time, I could feel the release of adrenalin. It hit my chest like > 360joules. Then the panic and anxiety would ensue. After reading The > Evolution, I see that psycho-social stress can produce adenomas. Huge > ah-ha moment for this critical care RN. > >>> > >>>During this time, I > suggested a possible pheochromocytoma diagnosis. With the uncontrollable > HTN and added microhematuria and mild proteinuria I was beginning to have > real concerns. Docs weren't buying that. Too rare. About as rare as PA. > But I kept pushing so they started chasing a Lupus diagnosis. The ANA was > negative and I was pronounced well, except for the psych issues > <sigh>. > >>> > >>>After graduation (1992), I went to work in a > community hospital med/surg ICU. At the same time, we moved and began > building the `dream house' we could now afford. My four children were > struggling to assimilate into a new environment and school. My oldest > daughter was living with us with her baby while her husband served in > Desert Storm. All four burners were full up and it wasn't long before I > began floundering. One night I went to bed. It felt like me HR was about > 200 and I could feel the PVCs. Each one made a pronounce thud in my chest > followed by a momentary brain haze. It got so intense I finally asked my > husband to take me to the ER. My potassium was 2.7. Their treatment of > cure was 20mEq of effervescent potassium po and serial labs. I was > released when my K+ hit 3.3. I was pronounced well and they sent me on my > way. > >>> > >>>I scheduled an appointment with my doctor who was still not > connecting the dots. He did add 20mEq of K+ daily to my meds. Things > stayed pretty much the same. On anti-depressants, then off, uncontrolled > HTN, micro hematuria, mild proteinuria, panic, anxiety off and on, same > stuff that everyone now considered my normal. > >>> > >>>We built the house, > kids were leaving one-by-one and the marriage had run its course. Divorce > was inevitable. During this period, I developed `severe' right flank pain. > It felt like if I could stick my finger inside my body up to my hand at > the level of my inferior rib, I could touch where the pain was located. > Now I get it. My doctor gave me some Vicodin which helped but I was > miserable, couldn't find a comfortable position and it went on for 2 > months. At that time he ordered a CT of my chest. God only knows why. The > right adrenal adenoma (or nodule as it was described) was uncovered. Still > not connecting the dots, him or me. > >>> > >>>That year I divorced and > relocated to Houston. I was happier and felt healthier. I was even able to > wean down my anti-hypertensives. This is when the issues with my back > began and the introduction of daily NSAIDs. It is now a concern for me > because I know there is an issue with combining NSAIDs and Spiro. Your > thoughts? > >>> > >>>More life changes. I moved back to Chicago October 2004 > and decided to give my failed marriage a second chance. It was less > stressful than it had been, but still acceptable. Soon, I started having a > lot of PVCs again. I was at work one night and decided to run a strip to > see if these were PACs of PVCs. They were PVCs (bigeminy, trigeminy, and > random). I had a nurse friend draw some blood and we sent it to lab. My > potassium was 2.8. I called the pharmacy and they sent me 100 mEq of K+. > It suppressed the PVCs for a few days but they returned. Again, I ran a > strip, drew blood, K+ was 3.0. Sent for a supplement and went to the > clinic. The doctor I had always seen left the Clinic, so I no longer had a > doctor. An Immediate Care physician saw me. He ordered a 24-hr Holter and > labs. The PVCs were ridiculously high. I know. I could feel every one. But > nothing was done. No follow-up, consultations, referrals, or > treatment. > >>> > >>>Things were deteriorating rapidly with the current > living situation, so I moved out. I began having severe lower leg and feet > cramps in 2008. I also was having frequent lower leg fasciculations, > particularly when I'd lay down. I started taking B12 for the cramping > which helped quite a bit. In January 2009 I moved to polis, MD to take > a job at s Hopkins. A death in the family brought me home again in > October 2009. I retired and it's been downhill ever since. > >>> > >>>Being > uninsured until July 2012 (Medicare), I was seeing a NP at a local > doc-in-a-box to get my prescriptions. I started having days filled with > PVCs and depression. I was started back on Doxepin. Labs showed my > potassium to be in the 3.0 to 3.2 range, a level that makes me > symptomatic. Knowing the cause, I finally just started treating it myself, > usually 80-120mEq over a day and a half and I would be okay for a couple > of weeks. It was during this time that it registered how often I was > urinating. It was so much that I finally bought a meter to check my BS. It > was and is normal as is my A1C. > >>> > >>>I needed a higher level of care so > I started seeing the PA at the doc-in-a-box thinking she would be > consulting with the in-house doctor regarding my care. After the initial > appointment, I was told they would no longer prescribe the Doxepin. The > doctor thought I was taking it for sleep or selling it, not sure which. I > also needed medication refills. The potassium called in was ½ my normal > dose. I freaked because I was almost out and having PVCs again. So I > gathered my history `evidence' and took it to the PA. She refused to > prescribe the correct amount after I told her I was self-medicating and > why with the proof in hand. After an embarrassing tete tete occurring in > front of staff and a waiting room full of patients, I stormed out. I asked > a friend pull a few strings (doctors won't see you if you're a self-pay > I've discovered) and I got in to see a family practice doc in September > 2011. > >>> > >>>Rather than have a staff member record my history > incorrectly, I put it in H & P format and handed it to the doctor. While > preparing the document, I decided to do some research on the causes of > chronic low potassium other than the obvious (thiazide diuretic, albuterol > inhaler, and recent rounds of prednisone for pneumonia). Imagine my > surprise when Conn's popped up and I finally connected the dots. I am THE > POSTER CHILD for Stage IV Conn's. > >>> > >>>When I had my appointment with > the family practice doc, I said, "The bilateral adrenal adenomas are > probably functional and it is highly likely that I have Conn's Syndrome". > I told him about the low potassium, my symptoms, and how I had been > treating it. Much to my surprise and without labs to back up my claim, he > prescribed K+ supplements equal to my bi-tri-weekly fix. However, no PA > blood or urine labs were ordered and his primary concern was the right > renal artery stenosis. The way I viewed that: if my aorta showed > calcification in 2000, it is highly likely that the renal artery is also > calcified. I thought that was probable because I have been mildly > hypercalcemic for years. That I attributed to higher blood calcium levels > secondary to CCB therapy. Now I am not so sure. > >>> > >>>I do have a > question: In your Evolution article you state that one of the symptoms of > the 34-year-old female was a positive Chevostek and Trousseau. Aren't > those tests reflective of low blood calcium? Also, my lab abnormalities > are often part of the earth metal/alkaline earth metal periodic family. Is > there a correlation other than the valence numbers? > >>> > >>>Also, a few > days a month about an hour after I take my meds, I start feeling > light-headed and strange. I know now that the feeling is related to > bradycardia and hypotension (HR 50's, BP 80's/30-40's). As the half-life > decreases the circulating levels, my HR and BP began looking like my > baseline (HR 70's, BP 140-150/80-90). When I feel that way, my radial > pulse is almost not palpable. Laying down, of course, helps. So, now I am > thinking that, on those days, my aldosterone is suppressed. Am I > right? > >>> > >>>Another thing: Around 2003-4 or so, we started using > Nesiritide (atrial natriuretic â€" ANH stimulator) instead of Dobutrex and > Primacor for our CHFers. In the Evolution article, you say that increased > vascular pressures promotes natriuresis. So, it follows that these > patients have decompensated and no longer respond to the body's > compensatory mechanism, correct? Also, does this have something to do with > the push for ACE inhibitors as the lead medication in treating > HTN? > >>> > >>>One more question: I am post-menopausal but did have night > sweats before menopause that I attributed to hormone levels. I still have > night sweats but these are different. I wake up about every two hours. At > first I feel almost afraid, my heart starts racing, then I feel completely > strange, then I get really hot. The onset of another symptom ends the > prior symptom. I've timed it from the fear feeling to the end. It lasts > about 4-5 minutes. Then everything returns to normal. This happens most > nights sometimes every two hours all night It even happens when I nap. It > is what wakes me up. I researched the symptoms and was thinking there was > a correlation to LH and FSH based on the q 2 hour cycle. I also considered > a release of cortisol. Now I wonder if it is part and parcel of the PA. > Any thoughts? Is aldosterone released in intervals? If so, what's the time > frame? > >>> > >>>Finally, of the Stage IV symptoms, these are the ones I've > experienced: profound hypokalemia, polyuria, drug resistant HTN, > hand/feet/leg cramps, profound weakness, periodic paralysis (onset when I > stand but then it subsides in a couple of minutes), arrhythmias, mild > proteinuria, and alkaline urine. > >>> > >>>There is so much more I am > probably leaving out, but I am sure you will ask the questions that will > free that information. So, thank you for your time and consideration. I'm > looking forward to the journey. > >>> > >>>Barbara Tatro > >>> > >>>Medical > History > >>> > >>>1. Hypertension â€" DX 1989 - age 42 â€" Severe and resistant > since DX > >>>2. Right Renal Artery Stenosis (70%) â€" 2009 > >>>3. Atrophic > right kidney > >>>4. Adrenal adenoma â€" Left 2.2 x 2.5; Right 2.1 x 1.2 > >>>Right diagnosed 2-2000 (1.5); Left diagnosed 6-2009 and increased size > of right adenoma (described as adrenal nodules) > >>>5. Hypokalemia > (profound â€" 1st incidence 1991, documented 2008-2011) > >>>6. Mild > hypercalcemia > >>>7. Hypomagnesemia > >>>8. Micro hematuria (small) > >>>9. > Mild proteinuria > >>>10. Aortic calcification > >>>11. Heat > Intolerance > >>>12. Back â€" T11-12 Central disc extrusion, mild central > canal stenosis; L1-2 bulging disc with compression of thecal sac; L2-3 > bulging disc compressing thecal sac; L3-4 bulging disc, retroliathesis, > central canal stenosis biforaminal stenosis; L4-5 unroofed disc, > spondyloliatheses, severe central canal and biforaminal stenosis; L5-S1 > extruded disc, left and right foraminal stenosis > >>>13. Left hip â€" joint > space narrowing and arthritic changes, subchondral sclerosis (rheumatoid > v. osteoarthritis) > >>>14. Left lateral leg neuropathy with atrophy > >>>15. > Falling > >>>16. Pneumonia â€" February, May, September 2011 > >>>17. Bilateral > otitis media â€" February, May, September 2011 > >>>18. COPD > >>>19. HPV > >>>20. > GI bleed â€" Diffuse gastritis â€" 2002 secondary to NSAID therapy > >>>21. > Fuch's Corneal Dystrophy (left eye severe, right eye mild to > moderate) > >>>22. Basal cell carcinoma left cheek > >>>23. Adenomyosis â€" > D & C x 3 1970's > >>>24. Fractures â€" right tibia, left thumb, spiral > fracture right 4th toe > >>>25. Seasonal allergies > >>>26. Chronic > pain > >>>27. Depression, anxiety and panic attacks, `nervous breakdown' x3 > â€" first at age 19 â€" about every 10 years thereafter â€" last one 1985 > >>>28. > Severe childhood abuse and molestation > >>>29. Smoker 1ppd x 40 > years > >>> > >>>Surgeries > >>>1. Exploratory lap, choleycystectomy - > 1977 > >>>2. Hysteroscopy â€" 1995 > >>>3. Removal basal cell carcinoma left > cheek â€" 2000 > >>> > >>>Family History > >>>1. Father (deceased) â€" CHF, multiple > MI, multiple CVA, Resistant HTN, Fuch's Corneal Dystrophy, depression, > HOH > >>>2. Mother (deceased) â€" HTN, cervical cancer, metastatic cancer > >>>3. Sister (68) â€" Fuch's corneal dystrophy, depression > >>>4. Brother > (66) â€" Bladder cancer, thyroid cancer, HTN, Type II Diabetes, > depression > >>>5. Brother (60) â€" HTN, Depression, dysrhythmia > >>>6. Brother > (46) - Dysrhythmia, depression > >>> > >>>Allergies > >>>1. Serotonin â€" Seizure, > anaphylaxis, Serotonin Syndrome (ER x3) > >>>2. Levaquin â€" Levaquin > Syndrome > >>>3. Wellbutrin â€" Cardiac dysrhythmia > >>> > >>>Prevention > >>>1. > Flu vaccine 11/2012 > >>>2. Pneumonia vaccine 11/2010 > >>> > >>>Medications > December - 2011 > >>> > >>>1. Lisinopril-Hctz 20/12.5 mg BID > >>>2. Verapamil > 120mg BID > >>>3. Labetalol 200mg BID > >>>4. Pravastatin 20mg Q night > >>>5. > Doxepin 75mg QD > >>>6. ASA 81mg BID > >>>7. Potassium 20 mEq BID > >>>8. > Doxepin 75 mg QD > >>>9. Ibuprofen 800mg BID > >>>10. Zyrtec 10 mg QD > >>>11. > Glucosam/Chon 1500/1200mg QD > >>>12. Vit B12 1000mcg QD > >>>13. Vit C 500mg > QD > >>>14. Magnesium 250mg BID > >>>15. Multi-Vit 1 tab QD > >>>16. Fish Oil > 1000 mg BID > >>>17. Ventolin Inhale 1-2 puffs PRN > >>>18. Naproxen 440mg > PRN > >>> > >>> > >> > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 15, 2012 Report Share Posted January 15, 2012 What do you mean. Ever tolerated salt?May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Jan 14, 2012, at 12:33, maggiekat7 <ljurkovic@...> wrote: My husband and I have been on the DASH diet since 2007 after his MI. We were given the literature at some point and it worked for him; he's still alive. For me, I have never tolerated salt, so it wasn't that big of a change; raised vegetarian, now more vegan, but I mostly had to make sure my carbs and protien were matched and that helped me lose the weight I needed to lose. Never had issues with BP until a few months ago, haven't changed the diet or exercise, just got high bp out of the blue and low potassium out of the blue. > >> > >> > >>>Dear Dr. Grim, > >>> > >>>I am a 64-year-old female. I am a retired > surgical heart ICU CCRN. I returned to college at age 39, and obtained a > BSN. I also student taught A & P and Micro labs for 12 years > post-graduation at Indiana University NW. I relocated to Houston, TX in > 2001. During my nursing tenure, I worked in community hospitals and for > several prestigious institutions including Methodist Hospital, Texas > Medical Center, Houston, for and with DeBakey. I also worked for > Hazim Safi's AAA unit at Memorial Hermann while in Houston. I have > presented at several critical care consortiums and served as clinical > educator at many of the facilities where I worked. > >>> > >>>So… looking > back on this medical journey confounds me. I, of all people, should have > done the research and found the answer. I attribute part of this > phenomenon to the lack of computer skills. I bought my first computer in > 2000. I wasn't what I would consider `computer literate' for a few more > years. By this time, I was easily 15 years into my PA odyssey and > convinced by professionals I trusted that my right adenoma was just an > `incidental' finding and quite common. I pride myself in my knowledge base > and assessment skills, but I very clearly dropped the ball when it came to > me. > >>> > >>>I do not hold contempt for the doctors who led me astray. If I > couldn't see the writing on the wall, why should they. I will say this, in > 20+ years of critical care nursing I never once cared for a patient with > PA as a primary or secondary diagnosis and I rarely cared for a patient > whose home medications included Spironolactone. Fewer still were > prescribed Spiro during their hospitalization. > >>> > >>>The beginning of > the end: I was diagnosed with HTN during a routine screening to begin my > nursing clinicals (age 42). The person who diagnosed it was an itty bitty > nun who was about 104. Poor thing could barely inflate the cuff. Her first > reading: 170/104. I assumed the extended inflation time had something to > do with it and asked that she repeat it. She did. No change. The doctor > that followed confirmed the DX. Begin the litany of BP meds dispensed so > conservatively, I am surprised I didn't stroke while waiting. Every change > that was made required a waiting period and another visit. Finally, a few > years in, I showed some progress. BPs were generally 140-150's/80-90's and > that was on a good day. The doc took the standard approach: started with a > diuretic then added a CCB, ACE, and finally a b-blocker. See attachment > for current medications. The b-blocker was Labetalol. When this was added > (due to the alpha blocking), I completely stopped have the adrenalin > rushes I had for years â€" so the offender was nor-epi and not epi? But this > created an anti-depressant dilemma: block it with one med, then hold it in > the synapse with another… hmmmm… the old come here, go away therapy. Any > suggestions because I am on both currently? > >>> > >>>From age 19 until my > diagnosis and treatment for clinical depression in 1985, I had repeated > episodes of depression, anxiety attacks, panic attacks, even agoraphobia. > When I was finally diagnosed, I was put on Doxepin and have taken it > intermittently since that time. My history includes severe child abuse and > molestation. So what do I do after I escaped? I, in essence, married my > father and the abuse and stress continued. I just kept throwing more logs > on the fire. I therefore attributed much of what I was experiencing to my > history. I assumed my resistant pressures were anxiety-driven. During this > time, I could feel the release of adrenalin. It hit my chest like > 360joules. Then the panic and anxiety would ensue. After reading The > Evolution, I see that psycho-social stress can produce adenomas. Huge > ah-ha moment for this critical care RN. > >>> > >>>During this time, I > suggested a possible pheochromocytoma diagnosis. With the uncontrollable > HTN and added microhematuria and mild proteinuria I was beginning to have > real concerns. Docs weren't buying that. Too rare. About as rare as PA. > But I kept pushing so they started chasing a Lupus diagnosis. The ANA was > negative and I was pronounced well, except for the psych issues > <sigh>. > >>> > >>>After graduation (1992), I went to work in a > community hospital med/surg ICU. At the same time, we moved and began > building the `dream house' we could now afford. My four children were > struggling to assimilate into a new environment and school. My oldest > daughter was living with us with her baby while her husband served in > Desert Storm. All four burners were full up and it wasn't long before I > began floundering. One night I went to bed. It felt like me HR was about > 200 and I could feel the PVCs. Each one made a pronounce thud in my chest > followed by a momentary brain haze. It got so intense I finally asked my > husband to take me to the ER. My potassium was 2.7. Their treatment of > cure was 20mEq of effervescent potassium po and serial labs. I was > released when my K+ hit 3.3. I was pronounced well and they sent me on my > way. > >>> > >>>I scheduled an appointment with my doctor who was still not > connecting the dots. He did add 20mEq of K+ daily to my meds. Things > stayed pretty much the same. On anti-depressants, then off, uncontrolled > HTN, micro hematuria, mild proteinuria, panic, anxiety off and on, same > stuff that everyone now considered my normal. > >>> > >>>We built the house, > kids were leaving one-by-one and the marriage had run its course. Divorce > was inevitable. During this period, I developed `severe' right flank pain. > It felt like if I could stick my finger inside my body up to my hand at > the level of my inferior rib, I could touch where the pain was located. > Now I get it. My doctor gave me some Vicodin which helped but I was > miserable, couldn't find a comfortable position and it went on for 2 > months. At that time he ordered a CT of my chest. God only knows why. The > right adrenal adenoma (or nodule as it was described) was uncovered. Still > not connecting the dots, him or me. > >>> > >>>That year I divorced and > relocated to Houston. I was happier and felt healthier. I was even able to > wean down my anti-hypertensives. This is when the issues with my back > began and the introduction of daily NSAIDs. It is now a concern for me > because I know there is an issue with combining NSAIDs and Spiro. Your > thoughts? > >>> > >>>More life changes. I moved back to Chicago October 2004 > and decided to give my failed marriage a second chance. It was less > stressful than it had been, but still acceptable. Soon, I started having a > lot of PVCs again. I was at work one night and decided to run a strip to > see if these were PACs of PVCs. They were PVCs (bigeminy, trigeminy, and > random). I had a nurse friend draw some blood and we sent it to lab. My > potassium was 2.8. I called the pharmacy and they sent me 100 mEq of K+. > It suppressed the PVCs for a few days but they returned. Again, I ran a > strip, drew blood, K+ was 3.0. Sent for a supplement and went to the > clinic. The doctor I had always seen left the Clinic, so I no longer had a > doctor. An Immediate Care physician saw me. He ordered a 24-hr Holter and > labs. The PVCs were ridiculously high. I know. I could feel every one. But > nothing was done. No follow-up, consultations, referrals, or > treatment. > >>> > >>>Things were deteriorating rapidly with the current > living situation, so I moved out. I began having severe lower leg and feet > cramps in 2008. I also was having frequent lower leg fasciculations, > particularly when I'd lay down. I started taking B12 for the cramping > which helped quite a bit. In January 2009 I moved to polis, MD to take > a job at s Hopkins. A death in the family brought me home again in > October 2009. I retired and it's been downhill ever since. > >>> > >>>Being > uninsured until July 2012 (Medicare), I was seeing a NP at a local > doc-in-a-box to get my prescriptions. I started having days filled with > PVCs and depression. I was started back on Doxepin. Labs showed my > potassium to be in the 3.0 to 3.2 range, a level that makes me > symptomatic. Knowing the cause, I finally just started treating it myself, > usually 80-120mEq over a day and a half and I would be okay for a couple > of weeks. It was during this time that it registered how often I was > urinating. It was so much that I finally bought a meter to check my BS. It > was and is normal as is my A1C. > >>> > >>>I needed a higher level of care so > I started seeing the PA at the doc-in-a-box thinking she would be > consulting with the in-house doctor regarding my care. After the initial > appointment, I was told they would no longer prescribe the Doxepin. The > doctor thought I was taking it for sleep or selling it, not sure which. I > also needed medication refills. The potassium called in was ½ my normal > dose. I freaked because I was almost out and having PVCs again. So I > gathered my history `evidence' and took it to the PA. She refused to > prescribe the correct amount after I told her I was self-medicating and > why with the proof in hand. After an embarrassing tete tete occurring in > front of staff and a waiting room full of patients, I stormed out. I asked > a friend pull a few strings (doctors won't see you if you're a self-pay > I've discovered) and I got in to see a family practice doc in September > 2011. > >>> > >>>Rather than have a staff member record my history > incorrectly, I put it in H & P format and handed it to the doctor. While > preparing the document, I decided to do some research on the causes of > chronic low potassium other than the obvious (thiazide diuretic, albuterol > inhaler, and recent rounds of prednisone for pneumonia). Imagine my > surprise when Conn's popped up and I finally connected the dots. I am THE > POSTER CHILD for Stage IV Conn's. > >>> > >>>When I had my appointment with > the family practice doc, I said, "The bilateral adrenal adenomas are > probably functional and it is highly likely that I have Conn's Syndrome". > I told him about the low potassium, my symptoms, and how I had been > treating it. Much to my surprise and without labs to back up my claim, he > prescribed K+ supplements equal to my bi-tri-weekly fix. However, no PA > blood or urine labs were ordered and his primary concern was the right > renal artery stenosis. The way I viewed that: if my aorta showed > calcification in 2000, it is highly likely that the renal artery is also > calcified. I thought that was probable because I have been mildly > hypercalcemic for years. That I attributed to higher blood calcium levels > secondary to CCB therapy. Now I am not so sure. > >>> > >>>I do have a > question: In your Evolution article you state that one of the symptoms of > the 34-year-old female was a positive Chevostek and Trousseau. Aren't > those tests reflective of low blood calcium? Also, my lab abnormalities > are often part of the earth metal/alkaline earth metal periodic family. Is > there a correlation other than the valence numbers? > >>> > >>>Also, a few > days a month about an hour after I take my meds, I start feeling > light-headed and strange. I know now that the feeling is related to > bradycardia and hypotension (HR 50's, BP 80's/30-40's). As the half-life > decreases the circulating levels, my HR and BP began looking like my > baseline (HR 70's, BP 140-150/80-90). When I feel that way, my radial > pulse is almost not palpable. Laying down, of course, helps. So, now I am > thinking that, on those days, my aldosterone is suppressed. Am I > right? > >>> > >>>Another thing: Around 2003-4 or so, we started using > Nesiritide (atrial natriuretic â€" ANH stimulator) instead of Dobutrex and > Primacor for our CHFers. In the Evolution article, you say that increased > vascular pressures promotes natriuresis. So, it follows that these > patients have decompensated and no longer respond to the body's > compensatory mechanism, correct? Also, does this have something to do with > the push for ACE inhibitors as the lead medication in treating > HTN? > >>> > >>>One more question: I am post-menopausal but did have night > sweats before menopause that I attributed to hormone levels. I still have > night sweats but these are different. I wake up about every two hours. At > first I feel almost afraid, my heart starts racing, then I feel completely > strange, then I get really hot. The onset of another symptom ends the > prior symptom. I've timed it from the fear feeling to the end. It lasts > about 4-5 minutes. Then everything returns to normal. This happens most > nights sometimes every two hours all night It even happens when I nap. It > is what wakes me up. I researched the symptoms and was thinking there was > a correlation to LH and FSH based on the q 2 hour cycle. I also considered > a release of cortisol. Now I wonder if it is part and parcel of the PA. > Any thoughts? Is aldosterone released in intervals? If so, what's the time > frame? > >>> > >>>Finally, of the Stage IV symptoms, these are the ones I've > experienced: profound hypokalemia, polyuria, drug resistant HTN, > hand/feet/leg cramps, profound weakness, periodic paralysis (onset when I > stand but then it subsides in a couple of minutes), arrhythmias, mild > proteinuria, and alkaline urine. > >>> > >>>There is so much more I am > probably leaving out, but I am sure you will ask the questions that will > free that information. So, thank you for your time and consideration. I'm > looking forward to the journey. > >>> > >>>Barbara Tatro > >>> > >>>Medical > History > >>> > >>>1. Hypertension â€" DX 1989 - age 42 â€" Severe and resistant > since DX > >>>2. Right Renal Artery Stenosis (70%) â€" 2009 > >>>3. Atrophic > right kidney > >>>4. Adrenal adenoma â€" Left 2.2 x 2.5; Right 2.1 x 1.2 > >>>Right diagnosed 2-2000 (1.5); Left diagnosed 6-2009 and increased size > of right adenoma (described as adrenal nodules) > >>>5. Hypokalemia > (profound â€" 1st incidence 1991, documented 2008-2011) > >>>6. Mild > hypercalcemia > >>>7. Hypomagnesemia > >>>8. Micro hematuria (small) > >>>9. > Mild proteinuria > >>>10. Aortic calcification > >>>11. Heat > Intolerance > >>>12. Back â€" T11-12 Central disc extrusion, mild central > canal stenosis; L1-2 bulging disc with compression of thecal sac; L2-3 > bulging disc compressing thecal sac; L3-4 bulging disc, retroliathesis, > central canal stenosis biforaminal stenosis; L4-5 unroofed disc, > spondyloliatheses, severe central canal and biforaminal stenosis; L5-S1 > extruded disc, left and right foraminal stenosis > >>>13. Left hip â€" joint > space narrowing and arthritic changes, subchondral sclerosis (rheumatoid > v. osteoarthritis) > >>>14. Left lateral leg neuropathy with atrophy > >>>15. > Falling > >>>16. Pneumonia â€" February, May, September 2011 > >>>17. Bilateral > otitis media â€" February, May, September 2011 > >>>18. COPD > >>>19. HPV > >>>20. > GI bleed â€" Diffuse gastritis â€" 2002 secondary to NSAID therapy > >>>21. > Fuch's Corneal Dystrophy (left eye severe, right eye mild to > moderate) > >>>22. Basal cell carcinoma left cheek > >>>23. Adenomyosis â€" > D & C x 3 1970's > >>>24. Fractures â€" right tibia, left thumb, spiral > fracture right 4th toe > >>>25. Seasonal allergies > >>>26. Chronic > pain > >>>27. Depression, anxiety and panic attacks, `nervous breakdown' x3 > â€" first at age 19 â€" about every 10 years thereafter â€" last one 1985 > >>>28. > Severe childhood abuse and molestation > >>>29. Smoker 1ppd x 40 > years > >>> > >>>Surgeries > >>>1. Exploratory lap, choleycystectomy - > 1977 > >>>2. Hysteroscopy â€" 1995 > >>>3. Removal basal cell carcinoma left > cheek â€" 2000 > >>> > >>>Family History > >>>1. Father (deceased) â€" CHF, multiple > MI, multiple CVA, Resistant HTN, Fuch's Corneal Dystrophy, depression, > HOH > >>>2. Mother (deceased) â€" HTN, cervical cancer, metastatic cancer > >>>3. Sister (68) â€" Fuch's corneal dystrophy, depression > >>>4. Brother > (66) â€" Bladder cancer, thyroid cancer, HTN, Type II Diabetes, > depression > >>>5. Brother (60) â€" HTN, Depression, dysrhythmia > >>>6. Brother > (46) - Dysrhythmia, depression > >>> > >>>Allergies > >>>1. Serotonin â€" Seizure, > anaphylaxis, Serotonin Syndrome (ER x3) > >>>2. Levaquin â€" Levaquin > Syndrome > >>>3. Wellbutrin â€" Cardiac dysrhythmia > >>> > >>>Prevention > >>>1. > Flu vaccine 11/2012 > >>>2. Pneumonia vaccine 11/2010 > >>> > >>>Medications > December - 2011 > >>> > >>>1. Lisinopril-Hctz 20/12.5 mg BID > >>>2. Verapamil > 120mg BID > >>>3. Labetalol 200mg BID > >>>4. Pravastatin 20mg Q night > >>>5. > Doxepin 75mg QD > >>>6. ASA 81mg BID > >>>7. Potassium 20 mEq BID > >>>8. > Doxepin 75 mg QD > >>>9. Ibuprofen 800mg BID > >>>10. Zyrtec 10 mg QD > >>>11. > Glucosam/Chon 1500/1200mg QD > >>>12. Vit B12 1000mcg QD > >>>13. Vit C 500mg > QD > >>>14. Magnesium 250mg BID > >>>15. Multi-Vit 1 tab QD > >>>16. Fish Oil > 1000 mg BID > >>>17. Ventolin Inhale 1-2 puffs PRN > >>>18. Naproxen 440mg > PRN > >>> > >>> > >> > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 15, 2012 Report Share Posted January 15, 2012 Never have liked salt and whenever I have too much (traveling, eating out, etc.) I get bloated. Retain water, go up a jean's size. So, I avoid it, ask for no added salt in restauants, don't use it at home except for baking which is rare. Don't like chocolate either. > > > >> > > > >> > > > >>>Dear Dr. Grim, > > > >>> > > > >>>I am a 64-year-old female. I am a retired > > > surgical heart ICU CCRN. I returned to college at age 39, and obtained a > > > BSN. I also student taught A & P and Micro labs for 12 years > > > post-graduation at Indiana University NW. I relocated to Houston, TX in > > > 2001. During my nursing tenure, I worked in community hospitals and for > > > several prestigious institutions including Methodist Hospital, Texas > > > Medical Center, Houston, for and with DeBakey. I also worked for > > > Hazim Safi's AAA unit at Memorial Hermann while in Houston. I have > > > presented at several critical care consortiums and served as clinical > > > educator at many of the facilities where I worked. > > > >>> > > > >>>So… looking > > > back on this medical journey confounds me. I, of all people, should have > > > done the research and found the answer. I attribute part of this > > > phenomenon to the lack of computer skills. I bought my first computer in > > > 2000. I wasn't what I would consider `computer literate' for a few more > > > years. By this time, I was easily 15 years into my PA odyssey and > > > convinced by professionals I trusted that my right adenoma was just an > > > `incidental' finding and quite common. I pride myself in my knowledge base > > > and assessment skills, but I very clearly dropped the ball when it came to > > > me. > > > >>> > > > >>>I do not hold contempt for the doctors who led me astray. If I > > > couldn't see the writing on the wall, why should they. I will say this, in > > > 20+ years of critical care nursing I never once cared for a patient with > > > PA as a primary or secondary diagnosis and I rarely cared for a patient > > > whose home medications included Spironolactone. Fewer still were > > > prescribed Spiro during their hospitalization. > > > >>> > > > >>>The beginning of > > > the end: I was diagnosed with HTN during a routine screening to begin my > > > nursing clinicals (age 42). The person who diagnosed it was an itty bitty > > > nun who was about 104. Poor thing could barely inflate the cuff. Her first > > > reading: 170/104. I assumed the extended inflation time had something to > > > do with it and asked that she repeat it. She did. No change. The doctor > > > that followed confirmed the DX. Begin the litany of BP meds dispensed so > > > conservatively, I am surprised I didn't stroke while waiting. Every change > > > that was made required a waiting period and another visit. Finally, a few > > > years in, I showed some progress. BPs were generally 140-150's/80-90's and > > > that was on a good day. The doc took the standard approach: started with a > > > diuretic then added a CCB, ACE, and finally a b-blocker. See attachment > > > for current medications. The b-blocker was Labetalol. When this was added > > > (due to the alpha blocking), I completely stopped have the adrenalin > > > rushes I had for years †" so the offender was nor-epi and not epi? But this > > > created an anti-depressant dilemma: block it with one med, then hold it in > > > the synapse with another… hmmmm… the old come here, go away therapy. Any > > > suggestions because I am on both currently? > > > >>> > > > >>>From age 19 until my > > > diagnosis and treatment for clinical depression in 1985, I had repeated > > > episodes of depression, anxiety attacks, panic attacks, even agoraphobia. > > > When I was finally diagnosed, I was put on Doxepin and have taken it > > > intermittently since that time. My history includes severe child abuse and > > > molestation. So what do I do after I escaped? I, in essence, married my > > > father and the abuse and stress continued. I just kept throwing more logs > > > on the fire. I therefore attributed much of what I was experiencing to my > > > history. I assumed my resistant pressures were anxiety-driven. During this > > > time, I could feel the release of adrenalin. It hit my chest like > > > 360joules. Then the panic and anxiety would ensue. After reading The > > > Evolution, I see that psycho-social stress can produce adenomas. Huge > > > ah-ha moment for this critical care RN. > > > >>> > > > >>>During this time, I > > > suggested a possible pheochromocytoma diagnosis. With the uncontrollable > > > HTN and added microhematuria and mild proteinuria I was beginning to have > > > real concerns. Docs weren't buying that. Too rare. About as rare as PA. > > > But I kept pushing so they started chasing a Lupus diagnosis. The ANA was > > > negative and I was pronounced well, except for the psych issues > > > <sigh>. > > > >>> > > > >>>After graduation (1992), I went to work in a > > > community hospital med/surg ICU. At the same time, we moved and began > > > building the `dream house' we could now afford. My four children were > > > struggling to assimilate into a new environment and school. My oldest > > > daughter was living with us with her baby while her husband served in > > > Desert Storm. All four burners were full up and it wasn't long before I > > > began floundering. One night I went to bed. It felt like me HR was about > > > 200 and I could feel the PVCs. Each one made a pronounce thud in my chest > > > followed by a momentary brain haze. It got so intense I finally asked my > > > husband to take me to the ER. My potassium was 2.7. Their treatment of > > > cure was 20mEq of effervescent potassium po and serial labs. I was > > > released when my K+ hit 3.3. I was pronounced well and they sent me on my > > > way. > > > >>> > > > >>>I scheduled an appointment with my doctor who was still not > > > connecting the dots. He did add 20mEq of K+ daily to my meds. Things > > > stayed pretty much the same. On anti-depressants, then off, uncontrolled > > > HTN, micro hematuria, mild proteinuria, panic, anxiety off and on, same > > > stuff that everyone now considered my normal. > > > >>> > > > >>>We built the house, > > > kids were leaving one-by-one and the marriage had run its course. Divorce > > > was inevitable. During this period, I developed `severe' right flank pain. > > > It felt like if I could stick my finger inside my body up to my hand at > > > the level of my inferior rib, I could touch where the pain was located. > > > Now I get it. My doctor gave me some Vicodin which helped but I was > > > miserable, couldn't find a comfortable position and it went on for 2 > > > months. At that time he ordered a CT of my chest. God only knows why. The > > > right adrenal adenoma (or nodule as it was described) was uncovered. Still > > > not connecting the dots, him or me. > > > >>> > > > >>>That year I divorced and > > > relocated to Houston. I was happier and felt healthier. I was even able to > > > wean down my anti-hypertensives. This is when the issues with my back > > > began and the introduction of daily NSAIDs. It is now a concern for me > > > because I know there is an issue with combining NSAIDs and Spiro. Your > > > thoughts? > > > >>> > > > >>>More life changes. I moved back to Chicago October 2004 > > > and decided to give my failed marriage a second chance. It was less > > > stressful than it had been, but still acceptable. Soon, I started having a > > > lot of PVCs again. I was at work one night and decided to run a strip to > > > see if these were PACs of PVCs. They were PVCs (bigeminy, trigeminy, and > > > random). I had a nurse friend draw some blood and we sent it to lab. My > > > potassium was 2.8. I called the pharmacy and they sent me 100 mEq of K+. > > > It suppressed the PVCs for a few days but they returned. Again, I ran a > > > strip, drew blood, K+ was 3.0. Sent for a supplement and went to the > > > clinic. The doctor I had always seen left the Clinic, so I no longer had a > > > doctor. An Immediate Care physician saw me. He ordered a 24-hr Holter and > > > labs. The PVCs were ridiculously high. I know. I could feel every one. But > > > nothing was done. No follow-up, consultations, referrals, or > > > treatment. > > > >>> > > > >>>Things were deteriorating rapidly with the current > > > living situation, so I moved out. I began having severe lower leg and feet > > > cramps in 2008. I also was having frequent lower leg fasciculations, > > > particularly when I'd lay down. I started taking B12 for the cramping > > > which helped quite a bit. In January 2009 I moved to polis, MD to take > > > a job at s Hopkins. A death in the family brought me home again in > > > October 2009. I retired and it's been downhill ever since. > > > >>> > > > >>>Being > > > uninsured until July 2012 (Medicare), I was seeing a NP at a local > > > doc-in-a-box to get my prescriptions. I started having days filled with > > > PVCs and depression. I was started back on Doxepin. Labs showed my > > > potassium to be in the 3.0 to 3.2 range, a level that makes me > > > symptomatic. Knowing the cause, I finally just started treating it myself, > > > usually 80-120mEq over a day and a half and I would be okay for a couple > > > of weeks. It was during this time that it registered how often I was > > > urinating. It was so much that I finally bought a meter to check my BS. It > > > was and is normal as is my A1C. > > > >>> > > > >>>I needed a higher level of care so > > > I started seeing the PA at the doc-in-a-box thinking she would be > > > consulting with the in-house doctor regarding my care. After the initial > > > appointment, I was told they would no longer prescribe the Doxepin. The > > > doctor thought I was taking it for sleep or selling it, not sure which. I > > > also needed medication refills. The potassium called in was ½ my normal > > > dose. I freaked because I was almost out and having PVCs again. So I > > > gathered my history `evidence' and took it to the PA. She refused to > > > prescribe the correct amount after I told her I was self-medicating and > > > why with the proof in hand. After an embarrassing tete tete occurring in > > > front of staff and a waiting room full of patients, I stormed out. I asked > > > a friend pull a few strings (doctors won't see you if you're a self-pay > > > I've discovered) and I got in to see a family practice doc in September > > > 2011. > > > >>> > > > >>>Rather than have a staff member record my history > > > incorrectly, I put it in H & P format and handed it to the doctor. While > > > preparing the document, I decided to do some research on the causes of > > > chronic low potassium other than the obvious (thiazide diuretic, albuterol > > > inhaler, and recent rounds of prednisone for pneumonia). Imagine my > > > surprise when Conn's popped up and I finally connected the dots. I am THE > > > POSTER CHILD for Stage IV Conn's. > > > >>> > > > >>>When I had my appointment with > > > the family practice doc, I said, " The bilateral adrenal adenomas are > > > probably functional and it is highly likely that I have Conn's Syndrome " . > > > I told him about the low potassium, my symptoms, and how I had been > > > treating it. Much to my surprise and without labs to back up my claim, he > > > prescribed K+ supplements equal to my bi-tri-weekly fix. However, no PA > > > blood or urine labs were ordered and his primary concern was the right > > > renal artery stenosis. The way I viewed that: if my aorta showed > > > calcification in 2000, it is highly likely that the renal artery is also > > > calcified. I thought that was probable because I have been mildly > > > hypercalcemic for years. That I attributed to higher blood calcium levels > > > secondary to CCB therapy. Now I am not so sure. > > > >>> > > > >>>I do have a > > > question: In your Evolution article you state that one of the symptoms of > > > the 34-year-old female was a positive Chevostek and Trousseau. Aren't > > > those tests reflective of low blood calcium? Also, my lab abnormalities > > > are often part of the earth metal/alkaline earth metal periodic family. Is > > > there a correlation other than the valence numbers? > > > >>> > > > >>>Also, a few > > > days a month about an hour after I take my meds, I start feeling > > > light-headed and strange. I know now that the feeling is related to > > > bradycardia and hypotension (HR 50's, BP 80's/30-40's). As the half-life > > > decreases the circulating levels, my HR and BP began looking like my > > > baseline (HR 70's, BP 140-150/80-90). When I feel that way, my radial > > > pulse is almost not palpable. Laying down, of course, helps. So, now I am > > > thinking that, on those days, my aldosterone is suppressed. Am I > > > right? > > > >>> > > > >>>Another thing: Around 2003-4 or so, we started using > > > Nesiritide (atrial natriuretic †" ANH stimulator) instead of Dobutrex and > > > Primacor for our CHFers. In the Evolution article, you say that increased > > > vascular pressures promotes natriuresis. So, it follows that these > > > patients have decompensated and no longer respond to the body's > > > compensatory mechanism, correct? Also, does this have something to do with > > > the push for ACE inhibitors as the lead medication in treating > > > HTN? > > > >>> > > > >>>One more question: I am post-menopausal but did have night > > > sweats before menopause that I attributed to hormone levels. I still have > > > night sweats but these are different. I wake up about every two hours. At > > > first I feel almost afraid, my heart starts racing, then I feel completely > > > strange, then I get really hot. The onset of another symptom ends the > > > prior symptom. I've timed it from the fear feeling to the end. It lasts > > > about 4-5 minutes. Then everything returns to normal. This happens most > > > nights sometimes every two hours all night It even happens when I nap. It > > > is what wakes me up. I researched the symptoms and was thinking there was > > > a correlation to LH and FSH based on the q 2 hour cycle. I also considered > > > a release of cortisol. Now I wonder if it is part and parcel of the PA. > > > Any thoughts? Is aldosterone released in intervals? If so, what's the time > > > frame? > > > >>> > > > >>>Finally, of the Stage IV symptoms, these are the ones I've > > > experienced: profound hypokalemia, polyuria, drug resistant HTN, > > > hand/feet/leg cramps, profound weakness, periodic paralysis (onset when I > > > stand but then it subsides in a couple of minutes), arrhythmias, mild > > > proteinuria, and alkaline urine. > > > >>> > > > >>>There is so much more I am > > > probably leaving out, but I am sure you will ask the questions that will > > > free that information. So, thank you for your time and consideration. I'm > > > looking forward to the journey. > > > >>> > > > >>>Barbara Tatro > > > >>> > > > >>>Medical > > > History > > > >>> > > > >>>1. Hypertension †" DX 1989 - age 42 †" Severe and resistant > > > since DX > > > >>>2. Right Renal Artery Stenosis (70%) †" 2009 > > > >>>3. Atrophic > > > right kidney > > > >>>4. Adrenal adenoma †" Left 2.2 x 2.5; Right 2.1 x 1.2 > > > >>>Right diagnosed 2-2000 (1.5); Left diagnosed 6-2009 and increased size > > > of right adenoma (described as adrenal nodules) > > > >>>5. Hypokalemia > > > (profound †" 1st incidence 1991, documented 2008-2011) > > > >>>6. Mild > > > hypercalcemia > > > >>>7. Hypomagnesemia > > > >>>8. Micro hematuria (small) > > > >>>9. > > > Mild proteinuria > > > >>>10. Aortic calcification > > > >>>11. Heat > > > Intolerance > > > >>>12. Back †" T11-12 Central disc extrusion, mild central > > > canal stenosis; L1-2 bulging disc with compression of thecal sac; L2-3 > > > bulging disc compressing thecal sac; L3-4 bulging disc, retroliathesis, > > > central canal stenosis biforaminal stenosis; L4-5 unroofed disc, > > > spondyloliatheses, severe central canal and biforaminal stenosis; L5-S1 > > > extruded disc, left and right foraminal stenosis > > > >>>13. Left hip †" joint > > > space narrowing and arthritic changes, subchondral sclerosis (rheumatoid > > > v. osteoarthritis) > > > >>>14. Left lateral leg neuropathy with atrophy > > > >>>15. > > > Falling > > > >>>16. Pneumonia †" February, May, September 2011 > > > >>>17. Bilateral > > > otitis media †" February, May, September 2011 > > > >>>18. COPD > > > >>>19. HPV > > > >>>20. > > > GI bleed †" Diffuse gastritis †" 2002 secondary to NSAID therapy > > > >>>21. > > > Fuch's Corneal Dystrophy (left eye severe, right eye mild to > > > moderate) > > > >>>22. Basal cell carcinoma left cheek > > > >>>23. Adenomyosis †" > > > D & C x 3 1970's > > > >>>24. Fractures †" right tibia, left thumb, spiral > > > fracture right 4th toe > > > >>>25. Seasonal allergies > > > >>>26. Chronic > > > pain > > > >>>27. Depression, anxiety and panic attacks, `nervous breakdown' x3 > > > †" first at age 19 †" about every 10 years thereafter †" last one 1985 > > > >>>28. > > > Severe childhood abuse and molestation > > > >>>29. Smoker 1ppd x 40 > > > years > > > >>> > > > >>>Surgeries > > > >>>1. Exploratory lap, choleycystectomy - > > > 1977 > > > >>>2. Hysteroscopy †" 1995 > > > >>>3. Removal basal cell carcinoma left > > > cheek †" 2000 > > > >>> > > > >>>Family History > > > >>>1. Father (deceased) †" CHF, multiple > > > MI, multiple CVA, Resistant HTN, Fuch's Corneal Dystrophy, depression, > > > HOH > > > >>>2. Mother (deceased) †" HTN, cervical cancer, metastatic cancer > > > >>>3. Sister (68) †" Fuch's corneal dystrophy, depression > > > >>>4. Brother > > > (66) †" Bladder cancer, thyroid cancer, HTN, Type II Diabetes, > > > depression > > > >>>5. Brother (60) †" HTN, Depression, dysrhythmia > > > >>>6. Brother > > > (46) - Dysrhythmia, depression > > > >>> > > > >>>Allergies > > > >>>1. Serotonin †" Seizure, > > > anaphylaxis, Serotonin Syndrome (ER x3) > > > >>>2. Levaquin †" Levaquin > > > Syndrome > > > >>>3. Wellbutrin †" Cardiac dysrhythmia > > > >>> > > > >>>Prevention > > > >>>1. > > > Flu vaccine 11/2012 > > > >>>2. Pneumonia vaccine 11/2010 > > > >>> > > > >>>Medications > > > December - 2011 > > > >>> > > > >>>1. Lisinopril-Hctz 20/12.5 mg BID > > > >>>2. Verapamil > > > 120mg BID > > > >>>3. Labetalol 200mg BID > > > >>>4. Pravastatin 20mg Q night > > > >>>5. > > > Doxepin 75mg QD > > > >>>6. ASA 81mg BID > > > >>>7. Potassium 20 mEq BID > > > >>>8. > > > Doxepin 75 mg QD > > > >>>9. Ibuprofen 800mg BID > > > >>>10. Zyrtec 10 mg QD > > > >>>11. > > > Glucosam/Chon 1500/1200mg QD > > > >>>12. Vit B12 1000mcg QD > > > >>>13. Vit C 500mg > > > QD > > > >>>14. Magnesium 250mg BID > > > >>>15. Multi-Vit 1 tab QD > > > >>>16. Fish Oil > > > 1000 mg BID > > > >>>17. Ventolin Inhale 1-2 puffs PRN > > > >>>18. Naproxen 440mg > > > PRN > > > >>> > > > >>> > > > >> > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 15, 2012 Report Share Posted January 15, 2012 Never have liked salt and whenever I have too much (traveling, eating out, etc.) I get bloated. Retain water, go up a jean's size. So, I avoid it, ask for no added salt in restauants, don't use it at home except for baking which is rare. Don't like chocolate either. > > > >> > > > >> > > > >>>Dear Dr. Grim, > > > >>> > > > >>>I am a 64-year-old female. I am a retired > > > surgical heart ICU CCRN. I returned to college at age 39, and obtained a > > > BSN. I also student taught A & P and Micro labs for 12 years > > > post-graduation at Indiana University NW. I relocated to Houston, TX in > > > 2001. During my nursing tenure, I worked in community hospitals and for > > > several prestigious institutions including Methodist Hospital, Texas > > > Medical Center, Houston, for and with DeBakey. I also worked for > > > Hazim Safi's AAA unit at Memorial Hermann while in Houston. I have > > > presented at several critical care consortiums and served as clinical > > > educator at many of the facilities where I worked. > > > >>> > > > >>>So… looking > > > back on this medical journey confounds me. I, of all people, should have > > > done the research and found the answer. I attribute part of this > > > phenomenon to the lack of computer skills. I bought my first computer in > > > 2000. I wasn't what I would consider `computer literate' for a few more > > > years. By this time, I was easily 15 years into my PA odyssey and > > > convinced by professionals I trusted that my right adenoma was just an > > > `incidental' finding and quite common. I pride myself in my knowledge base > > > and assessment skills, but I very clearly dropped the ball when it came to > > > me. > > > >>> > > > >>>I do not hold contempt for the doctors who led me astray. If I > > > couldn't see the writing on the wall, why should they. I will say this, in > > > 20+ years of critical care nursing I never once cared for a patient with > > > PA as a primary or secondary diagnosis and I rarely cared for a patient > > > whose home medications included Spironolactone. Fewer still were > > > prescribed Spiro during their hospitalization. > > > >>> > > > >>>The beginning of > > > the end: I was diagnosed with HTN during a routine screening to begin my > > > nursing clinicals (age 42). The person who diagnosed it was an itty bitty > > > nun who was about 104. Poor thing could barely inflate the cuff. Her first > > > reading: 170/104. I assumed the extended inflation time had something to > > > do with it and asked that she repeat it. She did. No change. The doctor > > > that followed confirmed the DX. Begin the litany of BP meds dispensed so > > > conservatively, I am surprised I didn't stroke while waiting. Every change > > > that was made required a waiting period and another visit. Finally, a few > > > years in, I showed some progress. BPs were generally 140-150's/80-90's and > > > that was on a good day. The doc took the standard approach: started with a > > > diuretic then added a CCB, ACE, and finally a b-blocker. See attachment > > > for current medications. The b-blocker was Labetalol. When this was added > > > (due to the alpha blocking), I completely stopped have the adrenalin > > > rushes I had for years †" so the offender was nor-epi and not epi? But this > > > created an anti-depressant dilemma: block it with one med, then hold it in > > > the synapse with another… hmmmm… the old come here, go away therapy. Any > > > suggestions because I am on both currently? > > > >>> > > > >>>From age 19 until my > > > diagnosis and treatment for clinical depression in 1985, I had repeated > > > episodes of depression, anxiety attacks, panic attacks, even agoraphobia. > > > When I was finally diagnosed, I was put on Doxepin and have taken it > > > intermittently since that time. My history includes severe child abuse and > > > molestation. So what do I do after I escaped? I, in essence, married my > > > father and the abuse and stress continued. I just kept throwing more logs > > > on the fire. I therefore attributed much of what I was experiencing to my > > > history. I assumed my resistant pressures were anxiety-driven. During this > > > time, I could feel the release of adrenalin. It hit my chest like > > > 360joules. Then the panic and anxiety would ensue. After reading The > > > Evolution, I see that psycho-social stress can produce adenomas. Huge > > > ah-ha moment for this critical care RN. > > > >>> > > > >>>During this time, I > > > suggested a possible pheochromocytoma diagnosis. With the uncontrollable > > > HTN and added microhematuria and mild proteinuria I was beginning to have > > > real concerns. Docs weren't buying that. Too rare. About as rare as PA. > > > But I kept pushing so they started chasing a Lupus diagnosis. The ANA was > > > negative and I was pronounced well, except for the psych issues > > > <sigh>. > > > >>> > > > >>>After graduation (1992), I went to work in a > > > community hospital med/surg ICU. At the same time, we moved and began > > > building the `dream house' we could now afford. My four children were > > > struggling to assimilate into a new environment and school. My oldest > > > daughter was living with us with her baby while her husband served in > > > Desert Storm. All four burners were full up and it wasn't long before I > > > began floundering. One night I went to bed. It felt like me HR was about > > > 200 and I could feel the PVCs. Each one made a pronounce thud in my chest > > > followed by a momentary brain haze. It got so intense I finally asked my > > > husband to take me to the ER. My potassium was 2.7. Their treatment of > > > cure was 20mEq of effervescent potassium po and serial labs. I was > > > released when my K+ hit 3.3. I was pronounced well and they sent me on my > > > way. > > > >>> > > > >>>I scheduled an appointment with my doctor who was still not > > > connecting the dots. He did add 20mEq of K+ daily to my meds. Things > > > stayed pretty much the same. On anti-depressants, then off, uncontrolled > > > HTN, micro hematuria, mild proteinuria, panic, anxiety off and on, same > > > stuff that everyone now considered my normal. > > > >>> > > > >>>We built the house, > > > kids were leaving one-by-one and the marriage had run its course. Divorce > > > was inevitable. During this period, I developed `severe' right flank pain. > > > It felt like if I could stick my finger inside my body up to my hand at > > > the level of my inferior rib, I could touch where the pain was located. > > > Now I get it. My doctor gave me some Vicodin which helped but I was > > > miserable, couldn't find a comfortable position and it went on for 2 > > > months. At that time he ordered a CT of my chest. God only knows why. The > > > right adrenal adenoma (or nodule as it was described) was uncovered. Still > > > not connecting the dots, him or me. > > > >>> > > > >>>That year I divorced and > > > relocated to Houston. I was happier and felt healthier. I was even able to > > > wean down my anti-hypertensives. This is when the issues with my back > > > began and the introduction of daily NSAIDs. It is now a concern for me > > > because I know there is an issue with combining NSAIDs and Spiro. Your > > > thoughts? > > > >>> > > > >>>More life changes. I moved back to Chicago October 2004 > > > and decided to give my failed marriage a second chance. It was less > > > stressful than it had been, but still acceptable. Soon, I started having a > > > lot of PVCs again. I was at work one night and decided to run a strip to > > > see if these were PACs of PVCs. They were PVCs (bigeminy, trigeminy, and > > > random). I had a nurse friend draw some blood and we sent it to lab. My > > > potassium was 2.8. I called the pharmacy and they sent me 100 mEq of K+. > > > It suppressed the PVCs for a few days but they returned. Again, I ran a > > > strip, drew blood, K+ was 3.0. Sent for a supplement and went to the > > > clinic. The doctor I had always seen left the Clinic, so I no longer had a > > > doctor. An Immediate Care physician saw me. He ordered a 24-hr Holter and > > > labs. The PVCs were ridiculously high. I know. I could feel every one. But > > > nothing was done. No follow-up, consultations, referrals, or > > > treatment. > > > >>> > > > >>>Things were deteriorating rapidly with the current > > > living situation, so I moved out. I began having severe lower leg and feet > > > cramps in 2008. I also was having frequent lower leg fasciculations, > > > particularly when I'd lay down. I started taking B12 for the cramping > > > which helped quite a bit. In January 2009 I moved to polis, MD to take > > > a job at s Hopkins. A death in the family brought me home again in > > > October 2009. I retired and it's been downhill ever since. > > > >>> > > > >>>Being > > > uninsured until July 2012 (Medicare), I was seeing a NP at a local > > > doc-in-a-box to get my prescriptions. I started having days filled with > > > PVCs and depression. I was started back on Doxepin. Labs showed my > > > potassium to be in the 3.0 to 3.2 range, a level that makes me > > > symptomatic. Knowing the cause, I finally just started treating it myself, > > > usually 80-120mEq over a day and a half and I would be okay for a couple > > > of weeks. It was during this time that it registered how often I was > > > urinating. It was so much that I finally bought a meter to check my BS. It > > > was and is normal as is my A1C. > > > >>> > > > >>>I needed a higher level of care so > > > I started seeing the PA at the doc-in-a-box thinking she would be > > > consulting with the in-house doctor regarding my care. After the initial > > > appointment, I was told they would no longer prescribe the Doxepin. The > > > doctor thought I was taking it for sleep or selling it, not sure which. I > > > also needed medication refills. The potassium called in was ½ my normal > > > dose. I freaked because I was almost out and having PVCs again. So I > > > gathered my history `evidence' and took it to the PA. She refused to > > > prescribe the correct amount after I told her I was self-medicating and > > > why with the proof in hand. After an embarrassing tete tete occurring in > > > front of staff and a waiting room full of patients, I stormed out. I asked > > > a friend pull a few strings (doctors won't see you if you're a self-pay > > > I've discovered) and I got in to see a family practice doc in September > > > 2011. > > > >>> > > > >>>Rather than have a staff member record my history > > > incorrectly, I put it in H & P format and handed it to the doctor. While > > > preparing the document, I decided to do some research on the causes of > > > chronic low potassium other than the obvious (thiazide diuretic, albuterol > > > inhaler, and recent rounds of prednisone for pneumonia). Imagine my > > > surprise when Conn's popped up and I finally connected the dots. I am THE > > > POSTER CHILD for Stage IV Conn's. > > > >>> > > > >>>When I had my appointment with > > > the family practice doc, I said, " The bilateral adrenal adenomas are > > > probably functional and it is highly likely that I have Conn's Syndrome " . > > > I told him about the low potassium, my symptoms, and how I had been > > > treating it. Much to my surprise and without labs to back up my claim, he > > > prescribed K+ supplements equal to my bi-tri-weekly fix. However, no PA > > > blood or urine labs were ordered and his primary concern was the right > > > renal artery stenosis. The way I viewed that: if my aorta showed > > > calcification in 2000, it is highly likely that the renal artery is also > > > calcified. I thought that was probable because I have been mildly > > > hypercalcemic for years. That I attributed to higher blood calcium levels > > > secondary to CCB therapy. Now I am not so sure. > > > >>> > > > >>>I do have a > > > question: In your Evolution article you state that one of the symptoms of > > > the 34-year-old female was a positive Chevostek and Trousseau. Aren't > > > those tests reflective of low blood calcium? Also, my lab abnormalities > > > are often part of the earth metal/alkaline earth metal periodic family. Is > > > there a correlation other than the valence numbers? > > > >>> > > > >>>Also, a few > > > days a month about an hour after I take my meds, I start feeling > > > light-headed and strange. I know now that the feeling is related to > > > bradycardia and hypotension (HR 50's, BP 80's/30-40's). As the half-life > > > decreases the circulating levels, my HR and BP began looking like my > > > baseline (HR 70's, BP 140-150/80-90). When I feel that way, my radial > > > pulse is almost not palpable. Laying down, of course, helps. So, now I am > > > thinking that, on those days, my aldosterone is suppressed. Am I > > > right? > > > >>> > > > >>>Another thing: Around 2003-4 or so, we started using > > > Nesiritide (atrial natriuretic †" ANH stimulator) instead of Dobutrex and > > > Primacor for our CHFers. In the Evolution article, you say that increased > > > vascular pressures promotes natriuresis. So, it follows that these > > > patients have decompensated and no longer respond to the body's > > > compensatory mechanism, correct? Also, does this have something to do with > > > the push for ACE inhibitors as the lead medication in treating > > > HTN? > > > >>> > > > >>>One more question: I am post-menopausal but did have night > > > sweats before menopause that I attributed to hormone levels. I still have > > > night sweats but these are different. I wake up about every two hours. At > > > first I feel almost afraid, my heart starts racing, then I feel completely > > > strange, then I get really hot. The onset of another symptom ends the > > > prior symptom. I've timed it from the fear feeling to the end. It lasts > > > about 4-5 minutes. Then everything returns to normal. This happens most > > > nights sometimes every two hours all night It even happens when I nap. It > > > is what wakes me up. I researched the symptoms and was thinking there was > > > a correlation to LH and FSH based on the q 2 hour cycle. I also considered > > > a release of cortisol. Now I wonder if it is part and parcel of the PA. > > > Any thoughts? Is aldosterone released in intervals? If so, what's the time > > > frame? > > > >>> > > > >>>Finally, of the Stage IV symptoms, these are the ones I've > > > experienced: profound hypokalemia, polyuria, drug resistant HTN, > > > hand/feet/leg cramps, profound weakness, periodic paralysis (onset when I > > > stand but then it subsides in a couple of minutes), arrhythmias, mild > > > proteinuria, and alkaline urine. > > > >>> > > > >>>There is so much more I am > > > probably leaving out, but I am sure you will ask the questions that will > > > free that information. So, thank you for your time and consideration. I'm > > > looking forward to the journey. > > > >>> > > > >>>Barbara Tatro > > > >>> > > > >>>Medical > > > History > > > >>> > > > >>>1. Hypertension †" DX 1989 - age 42 †" Severe and resistant > > > since DX > > > >>>2. Right Renal Artery Stenosis (70%) †" 2009 > > > >>>3. Atrophic > > > right kidney > > > >>>4. Adrenal adenoma †" Left 2.2 x 2.5; Right 2.1 x 1.2 > > > >>>Right diagnosed 2-2000 (1.5); Left diagnosed 6-2009 and increased size > > > of right adenoma (described as adrenal nodules) > > > >>>5. Hypokalemia > > > (profound †" 1st incidence 1991, documented 2008-2011) > > > >>>6. Mild > > > hypercalcemia > > > >>>7. Hypomagnesemia > > > >>>8. Micro hematuria (small) > > > >>>9. > > > Mild proteinuria > > > >>>10. Aortic calcification > > > >>>11. Heat > > > Intolerance > > > >>>12. Back †" T11-12 Central disc extrusion, mild central > > > canal stenosis; L1-2 bulging disc with compression of thecal sac; L2-3 > > > bulging disc compressing thecal sac; L3-4 bulging disc, retroliathesis, > > > central canal stenosis biforaminal stenosis; L4-5 unroofed disc, > > > spondyloliatheses, severe central canal and biforaminal stenosis; L5-S1 > > > extruded disc, left and right foraminal stenosis > > > >>>13. Left hip †" joint > > > space narrowing and arthritic changes, subchondral sclerosis (rheumatoid > > > v. osteoarthritis) > > > >>>14. Left lateral leg neuropathy with atrophy > > > >>>15. > > > Falling > > > >>>16. Pneumonia †" February, May, September 2011 > > > >>>17. Bilateral > > > otitis media †" February, May, September 2011 > > > >>>18. COPD > > > >>>19. HPV > > > >>>20. > > > GI bleed †" Diffuse gastritis †" 2002 secondary to NSAID therapy > > > >>>21. > > > Fuch's Corneal Dystrophy (left eye severe, right eye mild to > > > moderate) > > > >>>22. Basal cell carcinoma left cheek > > > >>>23. Adenomyosis †" > > > D & C x 3 1970's > > > >>>24. Fractures †" right tibia, left thumb, spiral > > > fracture right 4th toe > > > >>>25. Seasonal allergies > > > >>>26. Chronic > > > pain > > > >>>27. Depression, anxiety and panic attacks, `nervous breakdown' x3 > > > †" first at age 19 †" about every 10 years thereafter †" last one 1985 > > > >>>28. > > > Severe childhood abuse and molestation > > > >>>29. Smoker 1ppd x 40 > > > years > > > >>> > > > >>>Surgeries > > > >>>1. Exploratory lap, choleycystectomy - > > > 1977 > > > >>>2. Hysteroscopy †" 1995 > > > >>>3. Removal basal cell carcinoma left > > > cheek †" 2000 > > > >>> > > > >>>Family History > > > >>>1. Father (deceased) †" CHF, multiple > > > MI, multiple CVA, Resistant HTN, Fuch's Corneal Dystrophy, depression, > > > HOH > > > >>>2. Mother (deceased) †" HTN, cervical cancer, metastatic cancer > > > >>>3. Sister (68) †" Fuch's corneal dystrophy, depression > > > >>>4. Brother > > > (66) †" Bladder cancer, thyroid cancer, HTN, Type II Diabetes, > > > depression > > > >>>5. Brother (60) †" HTN, Depression, dysrhythmia > > > >>>6. Brother > > > (46) - Dysrhythmia, depression > > > >>> > > > >>>Allergies > > > >>>1. Serotonin †" Seizure, > > > anaphylaxis, Serotonin Syndrome (ER x3) > > > >>>2. Levaquin †" Levaquin > > > Syndrome > > > >>>3. Wellbutrin †" Cardiac dysrhythmia > > > >>> > > > >>>Prevention > > > >>>1. > > > Flu vaccine 11/2012 > > > >>>2. Pneumonia vaccine 11/2010 > > > >>> > > > >>>Medications > > > December - 2011 > > > >>> > > > >>>1. Lisinopril-Hctz 20/12.5 mg BID > > > >>>2. Verapamil > > > 120mg BID > > > >>>3. Labetalol 200mg BID > > > >>>4. Pravastatin 20mg Q night > > > >>>5. > > > Doxepin 75mg QD > > > >>>6. ASA 81mg BID > > > >>>7. Potassium 20 mEq BID > > > >>>8. > > > Doxepin 75 mg QD > > > >>>9. Ibuprofen 800mg BID > > > >>>10. Zyrtec 10 mg QD > > > >>>11. > > > Glucosam/Chon 1500/1200mg QD > > > >>>12. Vit B12 1000mcg QD > > > >>>13. Vit C 500mg > > > QD > > > >>>14. Magnesium 250mg BID > > > >>>15. Multi-Vit 1 tab QD > > > >>>16. Fish Oil > > > 1000 mg BID > > > >>>17. Ventolin Inhale 1-2 puffs PRN > > > >>>18. Naproxen 440mg > > > PRN > > > >>> > > > >>> > > > >> > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
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