Guest guest Posted January 15, 2012 Report Share Posted January 15, 2012 You want to look at the information and make your own decision after discussing with your team or others who have been doing this for 48 years and trained with Dr. Conn (me). 1. How soon do you want to feel a lot better?2. Can you DASH (and document by urine testing) to minimize the need for meds of any kind?CE Grim MD On Jan 15, 2012, at 8:44 PM, maggiekat7 wrote: So, from what I see on the internet...Epler is expensive, Spiro is cheap. Epler is selective, Spiro has been around longer, both seem to have a long list of possible side effects and there's a study that says that Epler is not more effective with supression of aldo. So, what's the story? What's everyone's preference? Any side effects that most have? What do I need to know? My cardio will give me either. My choice, what do I want? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 15, 2012 Report Share Posted January 15, 2012 After I had gynecomastia complete with breast lumps that required a mammogram I did a lot of research. If you do an advanced search on the subject " Spironolactone Side Effects, Is It Right For You? " you should find the 100 or so posts. (It is slanted toward the male gender but much of it applies to you and there are references to studies you might find interesting.) If I had a choice I would have started on Epler and quite possibly still doing well on it. I believe most doctors would use epler if they weren't forced to use the cheaper alternative. As I recall epler was 10 times more than spiro, dose to dose. but you'll need about twice as much. Make sure your doctor RXs it for HTN and not PA. I seriously considered switching to epler and finally decided to skip that step and go to surgery if feasible. (I do have a tumor and since flank and testis pain is focused on that same size, I'm betting it is the cause. AVS will hopefully be done in early Feb. There were two main reasons I decided to fore go the other MCB route. I found an article that explained increased cortisol caused by spiro in PTNs w/MDD was an issue. I could not find anything on the subject regrding epler. I also could not find out the possibility of the tumor increasing the production of aldosterone over time. While elper list many side effect, you need to also take into consideration many are to protect from greedy lawyers! I remember gyneocomastia was reported in 5.9% at low dose and 50+% in higher doses of spiro and around 2% (the same as a placebo) with epler. BTW, I was on a low dose, 25mg bid! I won't recommend which method to choose as that is a personal decision and there are pros and cons for both. I will recommend you go with epler if you decide the MCB route, the extra features in spiro are nothing you need, IMHO! (It looks like your doctor agrees since that is what she RXed!) - 65 yo super ob., fastidious male - 12mm X 13mm rt. a.adnoma with previous rt. flank pain. Treating with DASH. Stats w/o meds = BP 175/90 HR 59 BS 125. D/C Spironolactone 12/20/2011 due to adverse SX. Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, Gynecomastia, MDD and PTSD. Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin and Metformin 2000MG. Started washing Spironolactone 12/20/11 to prepare for AVS. > > So, from what I see on the internet...Epler is expensive, Spiro is cheap. Epler is selective, Spiro has been around longer, both seem to have a long list of possible side effects and there's a study that says that Epler is not more effective with supression of aldo. So, what's the story? What's everyone's preference? Any side effects that most have? What do I need to know? My cardio will give me either. My choice, what do I want? > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 15, 2012 Report Share Posted January 15, 2012 Dr. Grim, let me be a little more direct. If you had no restrictions which MCB would you RX? Do you feel one will work fster than the other? - 65 yo super ob., fastidious male - 12mm X 13mm rt. a.adnoma with previous rt. flank pain. Treating with DASH. Stats w/o meds = BP 175/90 HR 59 BS 125. D/C Spironolactone 12/20/2011 due to adverse SX. Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, Gynecomastia, MDD and PTSD. Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin and Metformin 2000MG. Started washing Spironolactone 12/20/11 to prepare for AVS. > > > So, from what I see on the internet...Epler is expensive, Spiro is > > cheap. Epler is selective, Spiro has been around longer, both seem > > to have a long list of possible side effects and there's a study > > that says that Epler is not more effective with supression of aldo. > > So, what's the story? What's everyone's preference? Any side effects > > that most have? What do I need to know? My cardio will give me > > either. My choice, what do I want? > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 16, 2012 Report Share Posted January 16, 2012 Do you recommend having a scan before doing AVS? If scan showed bump in both sides would you still have AVS? > > > > > > > So, from what I see on the internet...Epler is expensive, Spiro is > > > > cheap. Epler is selective, Spiro has been around longer, both seem > > > > to have a long list of possible side effects and there's a study > > > > that says that Epler is not more effective with supression of > > aldo. > > > > So, what's the story? What's everyone's preference? Any side > > effects > > > > that most have? What do I need to know? My cardio will give me > > > > either. My choice, what do I want? > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 16, 2012 Report Share Posted January 16, 2012 How long a track record do you normally require? (I'm surprised the picture isn't becoming clear after 10 years!) An item 60 years old is not necessarialy better than something 10 years old. in fact it is often the opposite! Does this have any bearing on your choices? Update in Primary Aldosteronism Stowasser http://jcem.endojournals.org/content/94/10/3623.long The authors concluded that the two drugs were of similar efficacy in reducing BP in patients with PA (24). With such data now available, the restrictions still imposed by health regulatory bodies in most countries against subsidized use of eplerenone for the treatment of PA may hopefully soon be lifted. I also found this summary and wondered how that impacted Table 1 Adverse events reported most frequently with eplerenone Adverse event Rate (%) of adverse event Hyperkalemia (K+ >5.5 mEq/L) 33% (eplerenone alone) 38% (eplerenone and enalapril) Hypertriglyceridemia 15% Hyponatremia 2.3% Mastodynia 0.8% (men) Abnormal vaginal bleeding 0.6% (women) Gynecomastia 0.5% (men) As you might have guessed, the gynecomastia number really caught my eye since I've seen that number in the 50% range for Spironolactone! Someday they will need to take QOL issues into consideration! - 65 yo super ob., fastidious male - 12mm X 13mm rt. a.adnoma with previous rt. flank pain. Treating with DASH. Stats w/o meds = BP 175/90 HR 59 BS 125. D/C Spironolactone 12/20/2011 due to adverse SX. Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, Gynecomastia, MDD and PTSD. Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin and Metformin 2000MG. Started washing Spironolactone 12/20/11 to prepare for AVS. > > > > > > > So, from what I see on the internet...Epler is expensive, Spiro is > > > > cheap. Epler is selective, Spiro has been around longer, both seem > > > > to have a long list of possible side effects and there's a study > > > > that says that Epler is not more effective with supression of > > aldo. > > > > So, what's the story? What's everyone's preference? Any side > > effects > > > > that most have? What do I need to know? My cardio will give me > > > > either. My choice, what do I want? > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 17, 2012 Report Share Posted January 17, 2012 Doesn't " me too " meds drive competition in the free market? If I apply your logic to the automobile industry, should there only be one brand! I know absolutely nothing about Premarin but is there something new and better developed after 50 years? Was it better than the alternative, nothing! To bring this back to the subject at hand. If you found a medicine, maybe originally developed for transgender therapy, did a remarkable job treating Conn's Syndrome you would probably use it. In fact, over time you found it worked so well you might recommend it as the treatment of choice, with DASH of course! (Boobs, so what - they are better than than a MI aren't they! Ladies, not to leave you out, your's is probably " just Middle Aged Woman's Syndrome " !) After 50 years, same timeframe as Premarin, somebody comes up with medicine that may work as well but without the sexual side effects. You recommend it as a second therapy after you find out you have screwed up the PTN's hormonal system. Now I wonder what would hppen if we reversed the order. Would PTN be more willing to try meds and DASH since it probably the best form of treatment and less invasive? Would people be more complient? Would treatment provide a better QOL? What the heck, let's not rush into anything. Give it another 10 or 15 years " trial " and then maybe we will give it a trial. - 65 yo super ob., fastidious male - 12mm X 13mm rt. a.adnoma with previous rt. flank pain. Treating with DASH. Stats w/o meds = BP 175/90 HR 59 BS 125. D/C Spironolactone 12/20/2011 due to adverse SX. Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, Gynecomastia, MDD and PTSD. Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin and Metformin 2000MG. Started washing Spironolactone 12/20/11 to prepare for AVS. > > > > > > > > > > > So, from what I see on the internet...Epler is expensive, Spiro is > > > > > > cheap. Epler is selective, Spiro has been around longer, both seem > > > > > > to have a long list of possible side effects and there's a study > > > > > > that says that Epler is not more effective with supression of > > > > aldo. > > > > > > So, what's the story? What's everyone's preference? Any side > > > > effects > > > > > > that most have? What do I need to know? My cardio will give me > > > > > > either. My choice, what do I want? > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 17, 2012 Report Share Posted January 17, 2012 And then we have Vioxx. > > > > > > > > > > > > > So, from what I see on the internet...Epler is expensive, Spiro is > > > > > > > cheap. Epler is selective, Spiro has been around longer, both seem > > > > > > > to have a long list of possible side effects and there's a study > > > > > > > that says that Epler is not more effective with supression of > > > > > aldo. > > > > > > > So, what's the story? What's everyone's preference? Any side > > > > > effects > > > > > > > that most have? What do I need to know? My cardio will give me > > > > > > > either. My choice, what do I want? > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 17, 2012 Report Share Posted January 17, 2012 And what is Vioxx? I tried to Google it and only got as far as " V-I " and " Secret " came up. I forgot what I was looking for! I finally remembered, after I remembered my testosterone level, and looked at it. It soon became apparent that it was a cash cow for some lawyers because of the greed of a manufacturer (Merck), IMHO. I suspect the outcome would have been much different if they had changed labeling as directed and initiated some negative testing when questions first rose! This comment brought a flashback: " Merck plans to appeal the $253.4 verdict jurors awarded on August 19 to Ernst's widow, Carol. The award reflects a combination of her husband's lost pay as a Wal-Mart produce manager, their mental anguish, her loss of companionship and punitive damages. " When I was in Vietnam a friend ran over a civilian and killed him. He settled for the expected lost earnings of the man, $52 U.S.! OH wait, I see he was a Walmart employee, maybe they make more than I think. With all the hungry lawyers I probably don't have time to look at every lawsuit, in fact, I don't even care unless it involves some of the uncessary meds that I took for years, Can I sue them because they should have been labeled, " Will not work with PA " ! Now, do you have any specifics on the subject at hand? Eplerenone (Lasix). I'm specifically looking for information on Cortisol and anything that might have a bearing on MDD. - 65 yo super ob., fastidious male - 12mm X 13mm rt. a.adnoma with previous rt. flank pain. Treating with DASH. Stats w/o meds = BP 175/90 HR 59 BS 125. D/C Spironolactone 12/20/2011 due to adverse SX. Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, Gynecomastia, MDD and PTSD. Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin and Metformin 2000MG. Started washing Spironolactone 12/20/11 to prepare for AVS. > > > > > > > > > > > > > > > So, from what I see on the internet...Epler is expensive, Spiro is > > > > > > > > cheap. Epler is selective, Spiro has been around longer, both seem > > > > > > > > to have a long list of possible side effects and there's a study > > > > > > > > that says that Epler is not more effective with supression of > > > > > > aldo. > > > > > > > > So, what's the story? What's everyone's preference? Any side > > > > > > effects > > > > > > > > that most have? What do I need to know? My cardio will give me > > > > > > > > either. My choice, what do I want? > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 17, 2012 Report Share Posted January 17, 2012 You were talking about why Dr Grim doesn't always Rx newer drugs. Vioxx was a newer drug. It is estimated that 29000 died as a results of taking it. From drugs.com Vioxx was withdrawn from the U.S. market in 2004. The manufacturer of Vioxx has announced a voluntary withdrawal of the drug from the U.S. and worldwide market. This withdrawal is due to safety concerns of an increased risk of cardiovascular events (including heart attack and stroke) in patients taking Vioxx. Vioxx is in a class of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). Vioxx works by reducing substances that cause inflammation, pain, and fever in the body. Vioxx is used to reduce pain, inflammation, and stiffness caused by osteoarthritis, rheumatoid arthritis and certain forms of juvenile rheumatoid arthritis; to manage acute pain in adults; to treat migraines; and to treat menstrual pain. > > > > > > > > > > > > > > > > > So, from what I see on the internet...Epler is expensive, Spiro is > > > > > > > > > cheap. Epler is selective, Spiro has been around longer, both seem > > > > > > > > > to have a long list of possible side effects and there's a study > > > > > > > > > that says that Epler is not more effective with supression of > > > > > > > aldo. > > > > > > > > > So, what's the story? What's everyone's preference? Any side > > > > > > > effects > > > > > > > > > that most have? What do I need to know? My cardio will give me > > > > > > > > > either. My choice, what do I want? > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 17, 2012 Report Share Posted January 17, 2012 Sorry Francis, I thought you would recognize Rhetoric (3. empty talk: fine-sounding but insincere or empty language Encarta ® World English Dictionary © & (P) 1998-2005 Microsoft Corporation. All rights reserved.) Let me state it differently, I don't give 2 hoots about Vioxx or Premarin or any other failed medicine unless it is Spironolactone or Eplerenone. I am not planning to use either but want a backup plan if AVS fails. - 65 yo super ob., fastidious male - 12mm X 13mm rt. a.adnoma with previous rt. flank pain. Treating with DASH. Stats w/o meds = BP 175/90 HR 59 BS 125. D/C Spironolactone 12/20/2011 due to adverse SX. Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, Gynecomastia, MDD and PTSD. Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin and Metformin 2000MG. Started washing Spironolactone 12/20/11 to prepare for AVS. > > > > > > > > > > > > > > > > > > > So, from what I see on the internet...Epler is expensive, Spiro is > > > > > > > > > > cheap. Epler is selective, Spiro has been around longer, both seem > > > > > > > > > > to have a long list of possible side effects and there's a study > > > > > > > > > > that says that Epler is not more effective with supression of > > > > > > > > aldo. > > > > > > > > > > So, what's the story? What's everyone's preference? Any side > > > > > > > > effects > > > > > > > > > > that most have? What do I need to know? My cardio will give me > > > > > > > > > > either. My choice, what do I want? > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 17, 2012 Report Share Posted January 17, 2012 Let's look at when you offer and the cost issue comes out. Have you explained the differences before you mention cost? Does the PTN atleast know what androgen is? (I found out about the time I was headed for a mammogram!) It's not that I didn't ask why when I started developing boobs! I wonder if it's more of an issue as we age since as I understand testosterone starts to deminish around age 35 and proceeds at about 1%/yr. (Does this happen with women also? Now I wonder how it works as we get further into treatment, say 10 years, and testosterone is normally 10% lower. Does " the computer " that we call the body recompute and block less androgen or do we simply " live with less " ? (I suspect the latter but have no way of knowing since nobody tests!) Maybe it's time to join Dr. Stowasser and force regulating bodies to bless Eplerenone for the treatment of PA! When is that ASH meeting!? My guess is the acceptance would change if the cost was similar and you discussed QOL issues! We'll talk about " the Cortisol effect " next month! I've got to see what I can find about it but since epler doesn't block androgen I presume it doesn't " Leak over " to the gene next door! (Sorry for the nonmedical terms, I'm still learning!) Hope we don't end up with Horse Piss on this one! - 65 yo super ob., fastidious male - 12mm X 13mm rt. a.adnoma with previous rt. flank pain. Treating with DASH. Stats w/o meds = BP 175/90 HR 59 BS 125. D/C Spironolactone 12/20/2011 due to adverse SX. Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, Gynecomastia, MDD and PTSD. Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin and Metformin 2000MG. Started washing Spironolactone 12/20/11 to prepare for AVS. > > > > > > > > > > > > > > > So, from what I see on the internet...Epler is expensive, Spiro is > > > > > > > > cheap. Epler is selective, Spiro has been around longer, both seem > > > > > > > > to have a long list of possible side effects and there's a study > > > > > > > > that says that Epler is not more effective with supression of > > > > > > aldo. > > > > > > > > So, what's the story? What's everyone's preference? Any side > > > > > > effects > > > > > > > > that most have? What do I need to know? My cardio will give me > > > > > > > > either. My choice, what do I want? > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Reply to sender | Reply to group | Reply via web post | Start a New Topic > > Messages in this topic (10) > > RECENT ACTIVITY: New Members 4 New Files 2 > > Visit Your Group > > MARKETPLACE > > Stay on top of your group activity without leaving the page you're on - Get the Toolbar now. > > > > > > Switch to: Text-Only, Daily Digest • Unsubscribe • Terms of Use > > . > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 17, 2012 Report Share Posted January 17, 2012 How many patients have you treated with MDD? > > > > > > > > > > > > > > > > > > > So, from what I see on the internet...Epler is expensive, Spiro is > > > > > > > > > > cheap. Epler is selective, Spiro has been around longer, both seem > > > > > > > > > > to have a long list of possible side effects and there's a study > > > > > > > > > > that says that Epler is not more effective with supression of > > > > > > > > aldo. > > > > > > > > > > So, what's the story? What's everyone's preference? Any side > > > > > > > > effects > > > > > > > > > > that most have? What do I need to know? My cardio will give me > > > > > > > > > > either. My choice, what do I want? > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 18, 2012 Report Share Posted January 18, 2012 Major depressive disorder ( MDD) (also known as recurrent depressive disorder, clinical depression, major depression, unipolar depression, or unipolar disorder) - 65 yo super ob., fastidious male - 12mm X 13mm rt. a.adnoma with previous rt. flank pain. Treating with DASH. Stats w/o meds = BP 175/90 HR 59 BS 125. D/C Spironolactone 12/20/2011 due to adverse SX. Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, Gynecomastia, MDD and PTSD. Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin and Metformin 2000MG. Started washing Spironolactone 12/20/11 to prepare for AVS. > > > > > > > > > > > > > > > > > > > > > > > So, from what I see on the internet...Epler is expensive, Spiro is > > > > > > > > > > > > cheap. Epler is selective, Spiro has been around longer, both seem > > > > > > > > > > > > to have a long list of possible side effects and there's a study > > > > > > > > > > > > that says that Epler is not more effective with supression of > > > > > > > > > > aldo. > > > > > > > > > > > > So, what's the story? What's everyone's preference? Any side > > > > > > > > > > effects > > > > > > > > > > > > that most have? What do I need to know? My cardio will give me > > > > > > > > > > > > either. My choice, what do I want? > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
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