Re: My labs were thrown out!

[Guest guest]

AND now it's 4th down and your becoming a nuisance so they are going to punt to get the ball away from them and into someone elses hands to lessen their risk. So..... Now go see the cardiologist and see what they can do............I suspect I never had a urine done right. First time never told me to put it in the fridge and I had never done one. I didn't know. The next few they only checked for metanepherines. Sad sad system......

And yes, unless you complain they will bill as normal. They did the work, they used the supplies, they want the reimbursement.

From: maggiekat7 <ljurkovic@...>Subject: My labs were thrown out!hyperaldosteronism Date: Tuesday, January 24, 2012, 3:10 PM

I made my usual morning call to Doc 3 (the one who ran all the plasma tests over again and ran a 24 hour urine test on January 12). He reran the tests because Doc 1 (endo who raised the issue of PA based on low k and htn) "didn't do them right, you need the urine test to look at the na secretion to know the correct reference for the results of plasma renin and aldosterone". So he was going to do them right. I had the blood drawn and turned in the urine jugs on Jan 12. I have been calling for the results for over a week now, every morning I leave a friendly message with my name, birthdate and that I am calling to get the results of my labs from Jan 12? Today, the nurse calls and says that the doc got the scan results which look good and to follow up with cardiologist now. Oh, and they called the lab to check on the 24 hour urine test. The lab said "there wasn't enough acid, so they threw it all out". So we don't have any results from that. If I want

to redo the test, I can pick up a new jug from them and lab sheet, drop it off and get it redone. If I want. Ok, so, all the labs that he drew plasma wise now have no reference na secretion. And I find all this out two weeks later? Do I get a refund or something? Do I still have to pay for these labs that tell me nothing? Did they bill for the urine one they threw out?Is this outrageous? Or what?

[Guest guest]

I feel like I'm in the twilight zone. My ins. just called regarding precert for

a CAT Scan ordered by doc 3. What CAT scan? Of what? I ask? Ins. says

adrenals...what? I had an MRI last Friday, I say. I ask when the precert was

initiated by Doc 3? Today. I told them not to worry about precerting a CAT

scan. I started the Epler today...how long does it take to lower bp for PA

people?

>

>

> From: maggiekat7 <ljurkovic@...>

> Subject: My labs were thrown out!

> hyperaldosteronism

> Date: Tuesday, January 24, 2012, 3:10 PM

>

>

>

>  

>

>

>

> I made my usual morning call to Doc 3 (the one who ran all the plasma tests

over again and ran a 24 hour urine test on January 12). He reran the tests

because Doc 1 (endo who raised the issue of PA based on low k and htn) " didn't

do them right, you need the urine test to look at the na secretion to know the

correct reference for the results of plasma renin and aldosterone " . So he was

going to do them right. I had the blood drawn and turned in the urine jugs on

Jan 12. I have been calling for the results for over a week now, every morning I

leave a friendly message with my name, birthdate and that I am calling to get

the results of my labs from Jan 12? Today, the nurse calls and says that the doc

got the scan results which look good and to follow up with cardiologist now. Oh,

and they called the lab to check on the 24 hour urine test. The lab said " there

wasn't enough acid, so they threw it all out " . So we don't have any results from

that. If I want to

> redo the test, I can pick up a new jug from them and lab sheet, drop it off

and get it redone. If I want.

>

> Ok, so, all the labs that he drew plasma wise now have no reference na

secretion. And I find all this out two weeks later? Do I get a refund or

something? Do I still have to pay for these labs that tell me nothing? Did they

bill for the urine one they threw out?

>

> Is this outrageous? Or what?

>

[Guest guest]

We need to collaborate and write on how to get throught the system after learning from our mistakes....if we ever get through it

From: maggiekat7 <ljurkovic@...>Subject: Re: My labs were thrown out!hyperaldosteronism Date: Tuesday, January 24, 2012, 3:35 PM

I feel like I'm in the twilight zone. My ins. just called regarding precert for a CAT Scan ordered by doc 3. What CAT scan? Of what? I ask? Ins. says adrenals...what? I had an MRI last Friday, I say. I ask when the precert was initiated by Doc 3? Today. I told them not to worry about precerting a CAT scan. I started the Epler today...how long does it take to lower bp for PA people?> > > From: maggiekat7 <ljurkovic@...>> Subject: My labs were thrown out!> hyperaldosteronism > Date: Tuesday, January 24, 2012, 3:10 PM> > > > Â > > > > I made my usual morning call to Doc 3 (the one who ran all the plasma tests over again and ran a 24

hour urine test on January 12). He reran the tests because Doc 1 (endo who raised the issue of PA based on low k and htn) "didn't do them right, you need the urine test to look at the na secretion to know the correct reference for the results of plasma renin and aldosterone". So he was going to do them right. I had the blood drawn and turned in the urine jugs on Jan 12. I have been calling for the results for over a week now, every morning I leave a friendly message with my name, birthdate and that I am calling to get the results of my labs from Jan 12? Today, the nurse calls and says that the doc got the scan results which look good and to follow up with cardiologist now. Oh, and they called the lab to check on the 24 hour urine test. The lab said "there wasn't enough acid, so they threw it all out". So we don't have any results from that. If I want to> redo the test, I can pick up a new jug from them and lab sheet, drop it off and get it

redone. If I want. > > Ok, so, all the labs that he drew plasma wise now have no reference na secretion. And I find all this out two weeks later? Do I get a refund or something? Do I still have to pay for these labs that tell me nothing? Did they bill for the urine one they threw out?> > Is this outrageous? Or what?>

[Guest guest]

If you DASH to BP will start down in a day.CE Grim MDOn Jan 24, 2012, at 4:56 PM, Bingham wrote: We need to collaborate and write on how to get throught the system after learning from our mistakes....if we ever get through it From: maggiekat7 <ljurkovic@...>Subject: Re: My labs were thrown out!hyperaldosteronism Date: Tuesday, January 24, 2012, 3:35 PM I feel like I'm in the twilight zone. My ins. just called regarding precert for a CAT Scan ordered by doc 3. What CAT scan? Of what? I ask? Ins. says adrenals...what? I had an MRI last Friday, I say. I ask when the precert was initiated by Doc 3? Today. I told them not to worry about precerting a CAT scan. I started the Epler today...how long does it take to lower bp for PA people?> > > From: maggiekat7 <ljurkovic@...>> Subject: My labs were thrown out!> hyperaldosteronism > Date: Tuesday, January 24, 2012, 3:10 PM> > > > Â > > > > I made my usual morning call to Doc 3 (the one who ran all the plasma tests over again and ran a 24 hour urine test on January 12). He reran the tests because Doc 1 (endo who raised the issue of PA based on low k and htn) "didn't do them right, you need the urine test to look at the na secretion to know the correct reference for the results of plasma renin and aldosterone". So he was going to do them right. I had the blood drawn and turned in the urine jugs on Jan 12. I have been calling for the results for over a week now, every morning I leave a friendly message with my name, birthdate and that I am calling to get the results of my labs from Jan 12? Today, the nurse calls and says that the doc got the scan results which look good and to follow up with cardiologist now. Oh, and they called the lab to check on the 24 hour urine test. The lab said "there wasn't enough acid, so they threw it all out". So we don't have any results from that. If I want to> redo the test, I can pick up a new jug from them and lab sheet, drop it off and get it redone. If I want. > > Ok, so, all the labs that he drew plasma wise now have no reference na secretion. And I find all this out two weeks later? Do I get a refund or something? Do I still have to pay for these labs that tell me nothing? Did they bill for the urine one they threw out?> > Is this outrageous? Or what?>

[Guest guest]

Read my instructions in the welcome below. Take them to your team. They have the concept right but did not carry it out. Someone gave you the wrong jug. Unless you produced very large urine volume. Welcome to the exciting world of Hyperaldosteronism You are in the right place! I am Dr. CE Grim a retired Professor of Medicine and Endocrinology. I have had a long standing interest is Primary Aldosteronism since medical school days when I saw my first patient with Primary Aldosteronism in 1963 as a 4th year medical student. I did a Nephrology Fellowship at Duke and an Endocrinology and Metabolism Fellowship with Dr. Conn (1969-70). I have been on the faculty of the University of MO, Indiana Univ, UCLA/ R. Drew, and the Medical College of Wisconsin in Divisions of Nephrology, Endocrinology, Hypertension, Cardiology and Epidemiology. I have published over 240 papers and book chapters in most areas of the broad discipline of High Blood Pressure. My CV is in our files for details. The GOAL of our group is to teach you and your health care team about the ins and outs of the causes, diagnosis and control of the many forms of hyperaldosteronism. The steps below will introduce you into the fascinating world of high blood pressure, salt and potassium and the role of the adrenal hormone aldosterone in health and disease. Doing these in sequence will save you time and effort in getting up to speed in taking control of you health and educating your own health care team. While we can’t make you a doctor we will make you into a pretty good BP doctor-a skill that you will have for life. 1. Overview: Read my article in our files on the evolution of PA (Evolution_of_PA-Grim.pdf ) and take to all members of health care team. Tell us what stage you believe you are in. This is a brief review of most causes of hyperaldosteronism, high blood pressure, low potassium (K). Be certain that you and your health care team understand the key role of excess diet salt in HTN and especially in PA. Go to: http://www.worldactiononsalt.com/evidence/treatment_trials.htm For a state of the art and science discussion of salt and health. 2. Other patients with hyperaldosteronism (Conn’s syndrome). Read our Conn's stories in our files and then give us your own in as much detail as you can. Dr. Conn was the first to describe this disease process and the syndrome is named after him. To see others' stories, on the Hyperaldosteronism home page, go to Files/Conn’s Stories. You'll find instructions in "A - How to put your story here.doc "Then send us your story in an email and then we will likely ask more questions and make suggestions before you upload it to our files. 3. Hyperaldosteronism and Salt: The deadly Duo. Eating Plan to control high blood pressure due to hyperaldosteronism and most others with high blood pressure. This will reduce your need for medications and in many will get your BP and K to goal without meds.. Get the DASH diet book by T. et al, read it and use it: $8 in paperback at your local bookstore. If they don’t have it ask them to order it for you. Learning to eat the DASH way will play a major role in your road to good BP and K control and, in many of our folks here, will revolutionize your life. Go to chapter 9 and do the 14 day challenge. Tell your Dr you are doing this as your BP may plummet if you are on other meds in only 2-3 days. or go to http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf download this 64 page booklet free and do the Week on the DASH Diet for 2 weeks. If you are on BP meds be prepared for a large fall in BP and let your Dr. know you are doing this. Or go to (but costs money) DASH Diet for Health ProgramThe DASH Diet for Health Program is designed to help you improve your eating and exercise habits. Twice each week we will provide you with information on our website about food, food preparation, eating out, losing weight, getting fit and much more. In addition to providing new information each week on our website, we create a web page specially for you where you can track progress in areas such as your weight, blood pressure, and exercise.http://www.dashforhealth.com/ I strongly recommend you get the book and read it now! 4. Measure your BP: Measure your BP daily so you can see if it is getting better. If you are taking meds be sure to tell your health care team you are doing this as your BP may plummet to normal quickly. We recommend you use a device you listen to and will help you learn how to do this. If this is not something you want to do we can teach a significant other how to do it. See sharedcareinc.com or email to sharedcare@... to order a video on how to do this. If you already have one we will teach you how to teach your health care team how to validate your device. Your life and health depends on accurate BP measurements. Go to the amricanheart.org and download the Guidelines for Human Blood Pressure Measurement. Insist the your health care team do BP the AHA way. Your life is in the hands of those who measure your BP. Never trust your life to an automatic BP machine unless you know it is accurate on YOU. 5. Genetics and your BP: Go to familyhistory.hhs.gov and do your detailed family medical history so we can review with you to help Dx familial causes of high blood pressure and heart disease. If BP runs in your family you may save lives in your family by checking their BP yourself. There is a brief discussion of this in my Evolution Article. 6. How to DX and treat PA: Go to our file/Conn's Articles of Note/Medications/Bravo spir 1973.pdf and read this article and take to your health care team. It is old but still one of the best in the medical management of PA. Also see our file from the Endocrine Society Guidelines on PA. Dr. Grim's Perfect Primary Aldosteronism Blood and Urine Testing to diagnose PA in one day. 1. Eat a high salt diet for 2 weeks-at least 4000 mg of Na a day.2. No BP meds in last 4-12 weeks depending on meds and Drs advice.3. Collect 24 hr urine for Na, K and creatinine and aldosterone. Do not lose a drop of this liquid gold. It is impossible to interpret the renin and aldo without this.4. The morning you finish the 24 hr urine have fasting blood drawn for renin, aldo and K using our guidelines to get an accurate K. Try to get this done about 1-4 hours after you have been out of bed.5. Send us the results with the normal values for your lab.6. If you ever have a salt (saline) infusion test for PA be certain to ask them to measure how much you pee during the 4 hours of the infusion. If it is 1-1.5 liter of urine it strongly suggests that you may have PA. If more tha 1.5 L you almost certainly have PA. I call this Dr. Grim’s “Quick Pee Test” for PA. Our PA Registry: If you have been Dxed with PA already and are on Rx or have had surgery please go to http://www.kwiksurveys.com/online-survey.php?surveyID=HIJIO_f2685379 and complete our survey with as much information as you know. If there is some information you don't know ask us and we will help. If you need to update this as you journey thru the diagnostic/treatment process you can add another entry but label it as Nameyymmdd. For example today 4/20/11 for me would be Grim110420. This way of writing the date is an ever increasing number and will allow us and you to sort your multiple entries into a dated order. We are working on a more extensive database. 8. Learn the language: If you are new to medical lingo then download the acroyms from bloodpressureline/message/291869. Salt and high blood pressure: To learn the state of the science of salt and blood pressure please spend some time looking at http://www.worldactiononsalt.com/evidence/treatment_trials.htm10. Become a HBP expert consumer: Expect that it will take at least several weeks to get all this digested and to learn the new language of high blood pressure health care. As most doctors and nurses in practice have had very little training in high blood pressure you must become an expert yourself. For example most have never had anyone listen with them with a double stethoscope to verify that they can hear BP sounds. We cannot make you a doctor but we will make you a pretty good BP doctor.11. How High Blood Pressure should be managed: Go to nih.gov and download and read the Joint National Commission (JNC) Report 7 to get an overview on current guidelines. I ask all my secretaries to read this so they can communicate the importance of high blood pressure to my patients. JNC 8 will be out soon.Then: get (and study) the Hypertension Primer from americanheart.org. This is the most up-to-date compendium of what is known about high blood pressure and what every Dr. should know when they graduate from Medical School. Every chapter is only 2-3 pages. Read one chapter every week-night and you will finish it in about a year. I am working on a reading guide for lay people for the Primer. Stay tuned.12. Ask us questions: Ask any questions about high blood pressure you want answered. That is what we are here for.13. One-on-one Consulting: I can provide individual consulting if you do not want to go public. If you want individual one-on-one consulting for you and your Doctor contract me directly at lowerbp2@....May your pressure be low!Clarence E. Grim BS, MS, MD, FACP, FACCBoard Certified in Internal Medicine, Geriatrics, and High Blood Pressure Specializing in Primary Aldosteronism and Difficult to Control High Blood Pressure. On Jan 24, 2012, at 1:17 PM, Bingham wrote: AND now it's 4th down and your becoming a nuisance so they are going to punt to get the ball away from them and into someone elses hands to lessen their risk. So..... Now go see the cardiologist and see what they can do............I suspect I never had a urine done right. First time never told me to put it in the fridge and I had never done one. I didn't know. The next few they only checked for metanepherines. Sad sad system...... And yes, unless you complain they will bill as normal. They did the work, they used the supplies, they want the reimbursement. From: maggiekat7 <ljurkovic@...>Subject: My labs were thrown out!hyperaldosteronism Date: Tuesday, January 24, 2012, 3:10 PM I made my usual morning call to Doc 3 (the one who ran all the plasma tests over again and ran a 24 hour urine test on January 12). He reran the tests because Doc 1 (endo who raised the issue of PA based on low k and htn) "didn't do them right, you need the urine test to look at the na secretion to know the correct reference for the results of plasma renin and aldosterone". So he was going to do them right. I had the blood drawn and turned in the urine jugs on Jan 12. I have been calling for the results for over a week now, every morning I leave a friendly message with my name, birthdate and that I am calling to get the results of my labs from Jan 12? Today, the nurse calls and says that the doc got the scan results which look good and to follow up with cardiologist now. Oh, and they called the lab to check on the 24 hour urine test. The lab said "there wasn't enough acid, so they threw it all out". So we don't have any results from that. If I want to redo the test, I can pick up a new jug from them and lab sheet, drop it off and get it redone. If I want. Ok, so, all the labs that he drew plasma wise now have no reference na secretion. And I find all this out two weeks later? Do I get a refund or something? Do I still have to pay for these labs that tell me nothing? Did they bill for the urine one they threw out?Is this outrageous? Or what?