Re: JC in NIH - protocol 00-CH-0160 CT-SCAN W/contrast

[Guest guest]

As has PA ITSELF we think do to the high salt and Aldo renalfibrosis. We have had at least two here who have gotten bumps in CR after CT with contrast. Don't recall of they were metformin. Might be good question to ask the NIH team. Cold it be that also high salt renal fibrosis of PA increases risk of contrast injury. They must have some good data to look at. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Apr 3, 2012, at 21:15, <jclark24p@...> wrote:

For you on Metformin - when I got here they immediately stopped my Metformin and are monitoring my blood glucose before every meal and at bedtime. Also at other times it seems to happen right after I harras the nurse! Is harrassing a nurse likely to cause my BS (that's Blood Sugar, ) to rise?

Okay, get serious! Why do they do it you ask, because Metformin has been shown to cause Kidney problems when you do a ct-scan with contrast! Dr. Bobby explained that me and Nurse Jill just came in and saw what I was working on and "Oh, Yea, a minimum of 2 days" so that may be a warning if your doctor insists w/contrast.

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[Guest guest]

Since your enjoyment is in harassing those nurses you create the fight or flight - like scenario (preparing for battlle) and your brain wants that glycogen store for quicker thinking and the killer sarcastic comeback and to be able to recall the right answer when they give you some wierdone!

For you on Metformin - when I got here they immediately stopped my Metformin and are monitoring my blood glucose before every meal and at bedtime. Also at other times it seems to happen right after I harras the nurse! Is harrassing a nurse likely to cause my BS (that's Blood Sugar, ) to rise?Okay, get serious! Why do they do it you ask, because Metformin has been shown to cause Kidney problems when you do a ct-scan with contrast! Dr. Bobby explained that me and Nurse Jill just came in and saw what I was working on and "Oh, Yea, a minimum of 2 days" so that may be a warning if your doctor insists w/contrast.....

[Guest guest]

The story dealing w/contrast is specifically addressing Metformin. It is

apparently related to the iodine material conflicting with something in

metformin. They recommend discontinuing it UNDER DOCTORS SUPERVISION (at least

2 days in advance apparentl) and not resuming for at least 48hrs and after

checking BUN and creatinine.

There's 13 meds listed and SXSs listed but I currently only have it in hard

copy. I have asked for an electrionic copy or will have to deal with it when I

get home.

I believe I can answer the PA question because we are still in the gathering

facts stage and it would be and error to use contrast when looking for a DX of

PA when you have a strong indication of PA.

I may try to ask some questions but they will probably directly relate to me.

Time is limited to even get my questions answered. (That may change tomorrow

when I think I will meed with the whole team and we discucuss what all these

tests have found and where we are headed!)

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> > For you on Metformin - when I got here they immediately stopped my Metformin

and are monitoring my blood glucose before every meal and at bedtime. Also at

other times it seems to happen right after I harras the nurse! Is harrassing a

nurse likely to cause my BS (that's Blood Sugar, ) to rise?

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> > Okay, get serious! Why do they do it you ask, because Metformin has been

shown to cause Kidney problems when you do a ct-scan with contrast! Dr. Bobby

explained that me and Nurse Jill just came in and saw what I was working on and

" Oh, Yea, a minimum of 2 days " so that may be a warning if your doctor insists

w/contrast.

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[Guest guest]

You are certainly right for some of them but not this one. When a PTN asks his

nurse to " Please shut the door " and Her response is " Why " and PTN responds

" Because I would like some privacy " and Nurse responds " There is no one in the

hall " and you respond " Please use the door and ask your supervisor to come in "

am I being harassing?

If you are NPO and off Metformin so they need to check sugar and the nurse needs

to also draw blood which releases the NPO. Your food has been delivered 1/2

hour early. Nurse needs to send blood, I understand and I too don't want it to

clot either. HOwever when other nurses can accomplish all this in 5 minutes and

you have to page her at 25 minutes and her response is " I have to find the test

case " am I being harassing?

I think you get the picture so I won't detail the rest. You have to understand

that when you have had 7 different nurses and 6 are extremely similar and one is

etremely dissimilar I notice the difference. I am qualified to be a management

consultant and trained in reading situations and environments. You seem to

think I paint everybody with the same brush, I use a seperate brush for each

person (you may consider them victims!) When I woke up this morning and saw

Nurse Vicki was a little nervous I'm not sure that I mumbled anything other than

" Good Morning " . When she was taking my BP and she failed to check oxygen I

simply wiggled my finger and pointed to the machine. She got a little more

flustered when I didn't talk but figured it out after the BP test ended and I

could nicely explain the " Grim Reality of proper BP reading " and suggested she

refer to chapter C103 of the Hypertension Primer. I wasn't rude or belittling

one bit but felt I needed to validate my source so she wouldn't think it was

something some mountain man from Vermont had dreamed up. She was very

attentive, promptly argued the automatic maachines were better and did not take

a second reading, I was on the bed with feet diangling! At least the next time

she let me sit in a chair with feet on the floor but continued to ask questions.

I was polite and didn't argue but became noncomplient when she tried to add

additional BP Meds until I spoke with my doctor who had RXed more meds after

upping Hydraxoline last night. (Have you tried that med, if not I highly

recommend you do, I've been on it a week, happy headache!)

The bottom line ,is I want you to know I am a professional who knows " when

to hold them and when to fold them " as Kenny Rodgers sings! I seldom abuse

anyone. In fact, I had 3 of " my " nurses stop by today that were working other

areas to " check in on me " ! Do you think they just might have needed " a dose of

JC " instead of stewing in the break room? I'll let you know how many come by

tomorrow or maybe I'll tell you about the kid in an elec. wheel chair that we

ment when the escort was wheeling me back and both were in the middle of the

aisle. We pulled over and his frown changed into a big grin when I said, " We

usually win in a game of Chicken but not today! " It looked like he may not have

" won " much lately but we both went away smiling, actually the escort too!

I'm gone to behave myself for my second cortisol test. Maggie you probably know

why they are reconfirming it! Dr. M was here within a few hours of my ct-scan

and he all but invited my 3 hypertensive children to come down and spend a

couple days with him! More on this tomorrow when I understand it a little

better. I probably have to find out when a good time for a family visit to D.C.

would be! On the bright side I am licensed to drive the bus and can give a

pretty good tour of the city!

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> For you on Metformin - when I got here they immediately stopped my Metformin

and are monitoring my blood glucose before every meal and at bedtime. Also at

other times it seems to happen right after I harras the nurse! Is harrassing a

nurse likely to cause my BS (that's Blood Sugar, ) to rise?

>

> Okay, get serious! Why do they do it you ask, because Metformin has been shown

to cause Kidney problems when you do a ct-scan with contrast! Dr. Bobby

explained that me and Nurse Jill just came in and saw what I was working on and

" Oh, Yea, a minimum of 2 days " so that may be a warning if your doctor insists

w/contrast.

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[Guest guest]

Twice, 2005 and 2010. They want me to go back further in the private sector and

see if I can find any more.

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> > > > For you on Metformin - when I got here they immediately stopped

> > my Metformin and are monitoring my blood glucose before every meal

> > and at bedtime. Also at other times it seems to happen right after I

> > harras the nurse! Is harrassing a nurse likely to cause my BS

> > (that's Blood Sugar, ) to rise?

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> > > > Okay, get serious! Why do they do it you ask, because Metformin

> > has been shown to cause Kidney problems when you do a ct-scan with

> > contrast! Dr. Bobby explained that me and Nurse Jill just came in

> > and saw what I was working on and " Oh, Yea, a minimum of 2 days " so

> > that may be a warning if your doctor insists w/contrast.

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[Guest guest]

A great scare tatic IMHO but incomplete. Of those 70 PTNs out of 633 were on

metformin or one of the 13 meds identified to contain metformin? Once you

eliminate those it would be interesting to see the numbers and know how big or

if there is a problem. Next week I may have time to dig deeper if this rises to

the top of my open issues pile.

In the meantime if you have questions I will quote the bottom of the sheet I was

given. " If you have any further questions, please contact one of the nurses in

the Diagnostic Radiology Department @ 301-402-0256, M-F 8AM-4PM "

>

[Guest guest]

Yes and the numbers are probably lower today than they were 10 - 15 years ago.

Maybe you should check the date of manufacture before you allow them to test!

And if you have a clearly identified adenoma in one gland on a scan w/o contrast

but find it and in addition another " highly likely " adenoma in the other along

with probable excess corisol and small potential adenomas in the " good " gland

when you use contrast which do you pick? Life is a bunch of choices, do you die

at age 90 from excess radiation or do you die at age 70 from inproper dx! The

choice is yours, you live with them or maybe not!

Well,I am finishing this Thurs. am because we took a break last night. I'm not

sure how it started and I remember how it ended but apparently there was a

little in the middle that while I participated in I wasn't aware of! Four

wonderful nurses were standing around with very concerned looks on their faces.

I told them if someone didn't start smiling I was going to call a " code blue "

and see if I could find someone who was happy! They all smiled and then there

were some comments and suggestions that probably not be repeated here! (They

all appeared to be in agreement!)

I felt it a priviledge to break up the bordom of their night shift at 2am but

probably not repeat the performance tonight!

Oh yea, in case you are wondering what happened, they are trying to get my blood

pressure down. They tried to do a do a double increase of Hydralizine

yesterday: from 10mgbid to 4 times a day and after 2 readings raised the dose to

25mg and that's when I became noncompliant! (I felt some possible side effects

when they gave me the second 10mg dose 2 hr after the first to " get on a

schedule " (I understand getting on a schedule but I would have delayed 2 hours

and got on that schedule(I know, I know Doctor's orders. I wish type A

personalities would swing slightly toward type B and develop a little patiences

but that's another story!)

I refused to change until I spoke to my doctor, she's an endo. She basically

agreed to drop the hydralizine back to 10mg bid and I let my guard down and let

her add Terazosin 5mg at bed time. Sounded safe enough. My nurse this morning,

Nurse Dianne, explained that terazosin has a long half-life and takes 2 1/2 hrs.

to reach its full effect. She felt it might be a good idea to consult with a

Card.

The short story is my BP went from 175/88 to 110/61 after the teraz. (which was

exactly what I had explained to my endo that I didn't want to happen before we

started!) My body appears to object being treated like a yo-yo! She didn't want

to contact a Card, BP was her responsibility as it can be managed by anyone!

(Right Dr. Grim!)

I agreed RX a 2.5 dose and reserved the right to go noncompliant depending how I

felt at bedtime! BTW, she was extremely happy with 110/61, I was not. She was

on her way to a conference so I told her we would go over the ACCORD Trial and

disuss her view on the J-Curve when she had a few minutes! (IMHO, If she is

responsible to treat BP she should know at least as much as the average PTN!)

Dr. Bobby just stopped by, big meeting with whole team is scheduled for tomorrow

late morning. He said to bring all my questions. I suggested he bring his

dinner - he indicated he follows the Greek tradition of eating around 4, I told

him Real Vermonters only eat after dark!

He asked a little about Vermont and indicated he had another PTN coming from Vt

in May! Now I have to research that, there's only ~500,000 people in VT!

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> > > > > > For you on Metformin - when I got here they immediately stopped

> > > > my Metformin and are monitoring my blood glucose before every meal

> > > > and at bedtime. Also at other times it seems to happen right after I

> > > > harras the nurse! Is harrassing a nurse likely to cause my BS

> > > > (that's Blood Sugar, ) to rise?

> > > > > >

> > > > > > Okay, get serious! Why do they do it you ask, because Metformin

> > > > has been shown to cause Kidney problems when you do a ct-scan with

> > > > contrast! Dr. Bobby explained that me and Nurse Jill just came in

> > > > and saw what I was working on and " Oh, Yea, a minimum of 2 days " so

> > > > that may be a warning if your doctor insists w/contrast.

> > > > > >

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[Guest guest]

Yes, I get the scope of this research project is limitted to me. That is why

they have such an intense 10-12 week schedule, mine is 12 and I suspect it is

because they saw something on the 2005 scan and may of had a damn good guess

before I got here. In fact, one of the doctors called me before I came and said

they were more concerned about my left adrenal than the right. Ct-scan with

contrast painted a perfect picture and appears to all but confirm a conclusion.

He didn't state it but welcomed my children down to visit anytime for a much

shorter visit (2 days maybe).

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[Guest guest]

My meeting with Dr. M. was not to provide me with a conclusion, It was to share

and explain the testing to date including the scans. He did it one on one to

allow me time to ask questions so I would be comfortable discussing with the

whole team tomorrow morning late. Our meeting ended at 6:45, my previously hot

dinner had been sitting on my table for an hour! My final question was to ask

if he had any children. His answer was " No " . The final " JC Harrassment " of the

day was to tell him I thought I knew why! He left with a relaxing and fleeting

smile had the luxury of thinking of his wonderful wife for 30 seconds as he

headed for " at least 3 more hours of work " . I left to find a microwave and

spend the next 28 hours (so far) wondering how my kids will react! And does that

include second generation?

BTW there was one gotcha moments for me when I asked if genes CYP11B2 and

CYP11B1 might come into play! When the pro sits a little further back in his

chair and gives you a 10 second stare you know you have just scored a point! I

won't win the game but sometimes you feel good just scoring a point! I may have

been on the right subject but not for the right reason! I wonder if the action

of Spirnolactone exasserbates the problem!

As for number of bumps, I saw one and he went into detail showing me how he knew

it was benign. In fact I stopped him and told him that was not a concern for

me. I will probably never read another one so if I want to have a guess as to

what is going on I will ask a local professional to read it and if I want to

really know what is going on I'll ask NIH to tell me! I know I have a 5yr

commitment and quite likely a lifetime to this project! (Pretty good return on

my $350 investment!)

I do not expect an answer tomorrow because I will be in the second day of a low

dose DEX test and then have a 2day high DEX test, then Cortisol, ACTH and Dex

levels Monday. Daily 24h urine ends Thurs with an AVS done Thurs if necessary.

Bun and creatinine on Friday, to see if okay to restart Metformin and an ACTH

stim test (aldo and cortisol up to 120 min and discharge if appropriate. If I

was a betting man I would bet the final recommendation will be to remove zero

anrenal glands at this point and the only other intelligent option will be to

remove two! Any takers?

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[Guest guest]

If you have time could you ask there thoughts on the age of 40 being the cut off

for not doing AVS.

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[Guest guest]

As I am 65 it is probably not relevent to my study.

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[Guest guest]

You must have missed my response (42054) to your question (42050). I detailed

the current phase so I believe you could draw a conclusion however until the

tests are completed they won't offer a decision and I feel if I do it only

becomes my opinion which I very probably could have offered before I came down.

They appear to be confirming my suspesion and I knew I was not being tested

correctly.

As to your suggestion to avoid removing both just stating the obvious. I won't

remove a foot to DM2 or a lung to cancer unless the alternatives are are worse

(It might even be death!) They will make a recomendation based on 12 days of

testing and I have great confidence it will be in my best interest! If surgery

is an option they are required by law to recommend at least two other places to

have it and NIH. (They encourage here by one of the best Lap. Surgeon for ADx

in the country so they can do further study on the tissue removed and will even

put my wife up for the duration of the hospital stay.)

You may find this hard to believe but I have approached this with both eyes wide

open and done a lot of considering of other options. I will certainly detail my

opinion when we conclude the test!

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[Guest guest]

Let me be perfectly clear. This is a research project that involves exactly one

individual and potentially his family. While it would be nice to have the

undivided attention of some of the best research scientists (IMHO) their time

and energy will not allow it! Besides since the protocol is not complete and

they have not published any intrim results that I know of, you would find them

on pubmed I imagine so it would be THEIR OPINION, IMHO

I paid ~$350 for the previdledge of being evaluated by some of the best in the

land (IMHO). In return I get follow up service for 5 years and maybe more but 5

is guaranteed! I get to return at any time if I need follow up for free. My

three children have already been invited down here for a couple of days, for

free - they may have to pay their own way. I'm not sure about my two

grandaughters! And the cost is Free, Absoultely Free, zilch but I understand

why they can not provide me and open book to any and all information that might

appear to involve PA. (I am already sure the would love to talk about their

knowledge if time permitted but they are so involved and dedicated (IMHO) I am

quite sure time does not permit.

And I got one hell of a bargin, 4 and maybe 6 for the price of one! And there

may be good information for my children to decide whether I have any more

genitacally related grand kids (and I will make no opinions be known there! And

since I have 4 living siblings the party MAY get bigger, I and qualified and

could probably rent a 56 passenger bus and could probably fill it. That

question will probably come up tomorrow (Depending on what I hear ;>))

I will also point out I have NEVER advocated a 40 yo cutoff for AVS! I have

posted results of other's research! Please don't shoot the messenger, I don't

practice medicine w/o a license so I don't have malpractice insurance!

I really have to go to bed to not repeat last night's experience, I hope!

..... please ignore the typos. I do not have the resources and am too

hurried to spend any more time and get it perfect!

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[Guest guest]

Are not some in you family under 40? Not all may want to be in study.

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[Guest guest]

Is you K still the same as what the VA said it was?

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[Guest guest]

If Dartmouth did research on PA then what they learned either was different from

you learned or they do not pass on what they learned to med students.

Darthmouth does do a lot of research in other fields. A lot of there income

comes from grants. Belive they have 12 full time labs.

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[Guest guest]

Did a search for Horton on Dartmouth web site. came up with Dr Horton who

I believe is the one you are referring to. Go to link to read some history on

him.

http://dartmed.dartmouth.edu/summer06/pdf/alumni_album.pdf

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