Guest guest Posted January 15, 2012 Report Share Posted January 15, 2012 That was how I was with salt before the adrenalectomy - I didn't use it, and when I ate out, I'd always gain weight from the water retention it caused. Once I gained 7 pounds from eating a single restaurant meal! > > > > >> > > > > >> > > > > >>>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 That was how I was with salt before the adrenalectomy - I didn't use it, and when I ate out, I'd always gain weight from the water retention it caused. Once I gained 7 pounds from eating a single restaurant meal! > > > > >> > > > > >> > > > > >>>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 And always accused of over salting as I recall, msmith! " Show me the pee " ! > > > > > >> > > > > > >> > > > > > >>>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 And always accused of over salting as I recall, msmith! " Show me the pee " ! > > > > > >> > > > > > >> > > > > > >>>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 get loseit and track your sodium. Goal is <1500 mg a day.CE Grim MDOn Jan 15, 2012, at 7:17 PM, maggiekat7 wrote: 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 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 get loseit and track your sodium. Goal is <1500 mg a day.CE Grim MDOn Jan 15, 2012, at 7:17 PM, maggiekat7 wrote: 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 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 Right and i don't think we ever saw the numbers. CE Grim MDOn Jan 15, 2012, at 7:31 PM, wrote: And always accused of over salting as I recall, msmith! "Show me the pee"! > > > > > >> > > > > > >> > > > > > >>>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 That's because I never saw the numbers - none of my medical team felt it was worth testing because they believed that I (a) never ate processed fast food junk and ( was diligent enough to read the labels on the few things I would consider eating that had labels (since when one cooks from fresh, things rarely have labels!). There was really nothing I could have changed; it's not as if a person who has fructose intolerance can go on the fruit and rice diet! I know, I know. A person who doesn't eat fast food or prepared processed garbage - hard to believe. But true then, and true now. > > > > > > > >> > > > > > > > >> > > > > > > > >>>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 Hokay. I have learned to use urine data to validate that a patient, who swears they are eating a low sodium diet (backed by their significant other) is in fact eating a low sodium diet. Most often they are not. Especially when we are first getting started on lowering salt intake. But after a time most are eating a low sodium diet. Those that cannot do this (get to a low sodium/high K intake) and who have high blood pressure measured at home I recommend starting meds for BP. I almost always recommend a diuretic first (have recently changed to chlorthalidone rather than hypdrochlorothiazide) and then go from their. Some will say "I want to try exercise, meditation, X herb etc". I say fine but show us the BPs. If it works then good. If not you will need to consider meds.\etc. CE Grim MDOn Jan 15, 2012, at 8:35 PM, msmith_1928 wrote: That's because I never saw the numbers - none of my medical team felt it was worth testing because they believed that I (a) never ate processed fast food junk and ( was diligent enough to read the labels on the few things I would consider eating that had labels (since when one cooks from fresh, things rarely have labels!). There was really nothing I could have changed; it's not as if a person who has fructose intolerance can go on the fruit and rice diet! I know, I know. A person who doesn't eat fast food or prepared processed garbage - hard to believe. But true then, and true now. > > > > > > > >> > > > > > > > >> > > > > > > > >>>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...
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