Re: Where did all the K Go! (So close and yet so far!)

[Guest guest]

When I talked with the folks at NIH about my version of poor

care/diagnostics/ego docs who chose not to refer even though they were out of

their league, etc, I was advised to, at a minimum, send a letter, along with the

relevant labs, notes, diagnosis, treatment plan, prognosis and so on from NIH to

the doctors, so that they, at a minimum, can learn. I intend to do that, but I

do not think I have irreversable damage, long term income loss, etc, so far as I

know at this point, at least. I get my results tomorrow or Friday. If I had

suffered such losses, I might get litigious.

>

> I did little detective work and think I have a handle on my K issues (lab

range = 3.5-5.0). When I started (8/3/05) it was 3.9 and two other readings

before 7/12/06 were 3.8 and 3.7. Two weeks later, 7/12/06, it was 3.3! They

must have decided something was amiss because they took two more readings before

adding K supplements on 11/17/06, both readings = 3.2.

>

> The lead doctor for that team got involved on 8/7/06 and ordered a 24hr urine

test for Cortisol Free, results = 35.5 (range 4.0-50.0) Guess I passed! Hmmm

wait minute, volume was 1950. Didn't I hear over 1500 was suspect for

something? PA maybe? Never mind, his Cortisol was ok!

>

> I must have still complained because they " fixed the problem " in November by

adding the K supplements. Wait a minute, maybe that didn't fix it - PTN is back

on 2/7/07 and K = 3.5. 2 week recall it =3.6. I don't recognize the doctor,

she was probably in immediate care, but she ordered renin and aldo. Results,

renin=0.1 and aldo = 5 and a ct-scan showed a 12mmX13mm adenoma in the right

adrenal. With aldo in range she must have assumed the rest could be ignored

because that is exactly what happened for the next 3 ½ years!

>

> Wait a minute , look at that lab report again. What does " Low-renin

sodium/volume-mediated hypertension likely: <0.65 " and " Primary aldosteronsim

possible: <0.65 " mean? Maybe they went over that the day I went skiing! What

is this PA crap, that's Conn's isn't it? It's so rare, what are the odds that I

would catch a case in my first year out of school? Guess I can just ignore it!

>

> Well Cogbill, the odds of you hitting one was 100%. The odds of you

identifying it was 0%. The odds of me being in pain for an additional 4 years

and never being able to return to work was 100%. Yes, I ended up with LVH and

required oxygen for 1 ½ years. Yes, OSA worsened. Yes, I ended up with T2DM

and COPD. Suggest you review current info on PA and find it affects ~10% of the

people with HTN! (God, I wish I knew where she is today just to give her the

final chapter. She got closer than anyone else!) Never mind, I do know where

the supervising doctor is and maybe I will point this out to him, no reason to

waste good research!

>

> Aren't complete electronic medical records great. Sure is easy to be a

" Monday Morning Quarterback " ! That is not my goal but I do hope to show them

how close they were and maybe they will take that last step next time! We

sometimes need to " think outside the box " !

>

[Guest guest]

Excellent. What meds if any were u on ate these times. What was 24 hr urine Na and K on day of renin aldo test. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Mar 21, 2012, at 18:13, <jclark24p@...> wrote:

I did little detective work and think I have a handle on my K issues (lab range = 3.5-5.0). When I started (8/3/05) it was 3.9 and two other readings before 7/12/06 were 3.8 and 3.7. Two weeks later, 7/12/06, it was 3.3! They must have decided something was amiss because they took two more readings before adding K supplements on 11/17/06, both readings = 3.2.

The lead doctor for that team got involved on 8/7/06 and ordered a 24hr urine test for Cortisol Free, results = 35.5 (range 4.0-50.0) Guess I passed! Hmmm wait minute, volume was 1950. Didn't I hear over 1500 was suspect for something? PA maybe? Never mind, his Cortisol was ok!

I must have still complained because they "fixed the problem" in November by adding the K supplements. Wait a minute, maybe that didn't fix it - PTN is back on 2/7/07 and K = 3.5. 2 week recall it =3.6. I don't recognize the doctor, she was probably in immediate care, but she ordered renin and aldo. Results, renin=0.1 and aldo = 5 and a ct-scan showed a 12mmX13mm adenoma in the right adrenal. With aldo in range she must have assumed the rest could be ignored because that is exactly what happened for the next 3 ½ years!

Wait a minute , look at that lab report again. What does "Low-renin sodium/volume-mediated hypertension likely: <0.65" and "Primary aldosteronsim possible: <0.65" mean? Maybe they went over that the day I went skiing! What is this PA crap, that's Conn's isn't it? It's so rare, what are the odds that I would catch a case in my first year out of school? Guess I can just ignore it!

Well Cogbill, the odds of you hitting one was 100%. The odds of you identifying it was 0%. The odds of me being in pain for an additional 4 years and never being able to return to work was 100%. Yes, I ended up with LVH and required oxygen for 1 ½ years. Yes, OSA worsened. Yes, I ended up with T2DM and COPD. Suggest you review current info on PA and find it affects ~10% of the people with HTN! (God, I wish I knew where she is today just to give her the final chapter. She got closer than anyone else!) Never mind, I do know where the supervising doctor is and maybe I will point this out to him, no reason to waste good research!

Aren't complete electronic medical records great. Sure is easy to be a "Monday Morning Quarterback"! That is not my goal but I do hope to show them how close they were and maybe they will take that last step next time! We sometimes need to "think outside the box"!

[Guest guest]

Their advice sounds familiar it seems to me. ;-)May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Mar 21, 2012, at 18:47, maggiekat7 <ljurkovic@...> wrote:

When I talked with the folks at NIH about my version of poor care/diagnostics/ego docs who chose not to refer even though they were out of their league, etc, I was advised to, at a minimum, send a letter, along with the relevant labs, notes, diagnosis, treatment plan, prognosis and so on from NIH to the doctors, so that they, at a minimum, can learn. I intend to do that, but I do not think I have irreversable damage, long term income loss, etc, so far as I know at this point, at least. I get my results tomorrow or Friday. If I had suffered such losses, I might get litigious.

>

> I did little detective work and think I have a handle on my K issues (lab range = 3.5-5.0). When I started (8/3/05) it was 3.9 and two other readings before 7/12/06 were 3.8 and 3.7. Two weeks later, 7/12/06, it was 3.3! They must have decided something was amiss because they took two more readings before adding K supplements on 11/17/06, both readings = 3.2.

>

> The lead doctor for that team got involved on 8/7/06 and ordered a 24hr urine test for Cortisol Free, results = 35.5 (range 4.0-50.0) Guess I passed! Hmmm wait minute, volume was 1950. Didn't I hear over 1500 was suspect for something? PA maybe? Never mind, his Cortisol was ok!

>

> I must have still complained because they "fixed the problem" in November by adding the K supplements. Wait a minute, maybe that didn't fix it - PTN is back on 2/7/07 and K = 3.5. 2 week recall it =3.6. I don't recognize the doctor, she was probably in immediate care, but she ordered renin and aldo. Results, renin=0.1 and aldo = 5 and a ct-scan showed a 12mmX13mm adenoma in the right adrenal. With aldo in range she must have assumed the rest could be ignored because that is exactly what happened for the next 3 ½ years!

>

> Wait a minute , look at that lab report again. What does "Low-renin sodium/volume-mediated hypertension likely: <0.65" and "Primary aldosteronsim possible: <0.65" mean? Maybe they went over that the day I went skiing! What is this PA crap, that's Conn's isn't it? It's so rare, what are the odds that I would catch a case in my first year out of school? Guess I can just ignore it!

>

> Well Cogbill, the odds of you hitting one was 100%. The odds of you identifying it was 0%. The odds of me being in pain for an additional 4 years and never being able to return to work was 100%. Yes, I ended up with LVH and required oxygen for 1 ½ years. Yes, OSA worsened. Yes, I ended up with T2DM and COPD. Suggest you review current info on PA and find it affects ~10% of the people with HTN! (God, I wish I knew where she is today just to give her the final chapter. She got closer than anyone else!) Never mind, I do know where the supervising doctor is and maybe I will point this out to him, no reason to waste good research!

>

> Aren't complete electronic medical records great. Sure is easy to be a "Monday Morning Quarterback"! That is not my goal but I do hope to show them how close they were and maybe they will take that last step next time! We sometimes need to "think outside the box"!

>

[Guest guest]

I just reviewed clinic notes for 2006 (~135 pages) and boy was I a pain in the

ass! I didn't track meds but will go back and see what I can come up with in a

few days. (I saw your question after I read the notes.) I can tell you meds

were being " bounced " due to hives and PTSD and MDD were being actively persued

and meds being adjusted!

>

> > I did little detective work and think I have a handle on my K issues (lab

range = 3.5-5.0). When I started (8/3/05) it was 3.9 and two other readings

before 7/12/06 were 3.8 and 3.7. Two weeks later, 7/12/06, it was 3.3! They must

have decided something was amiss because they took two more readings before

adding K supplements on 11/17/06, both readings = 3.2.

> >

> > The lead doctor for that team got involved on 8/7/06 and ordered a 24hr

urine test for Cortisol Free, results = 35.5 (range 4.0-50.0) Guess I passed!

Hmmm wait minute, volume was 1950. Didn't I hear over 1500 was suspect for

something? PA maybe? Never mind, his Cortisol was ok!

> >

> > I must have still complained because they " fixed the problem " in November by

adding the K supplements. Wait a minute, maybe that didn't fix it - PTN is back

on 2/7/07 and K = 3.5. 2 week recall it =3.6. I don't recognize the doctor, she

was probably in immediate care, but she ordered renin and aldo. Results,

renin=0.1 and aldo = 5 and a ct-scan showed a 12mmX13mm adenoma in the right

adrenal. With aldo in range she must have assumed the rest could be ignored

because that is exactly what happened for the next 3 ½ years!

> >

> > Wait a minute , look at that lab report again. What does " Low-renin

sodium/volume-mediated hypertension likely: <0.65 " and " Primary aldosteronsim

possible: <0.65 " mean? Maybe they went over that the day I went skiing! What is

this PA crap, that's Conn's isn't it? It's so rare, what are the odds that I

would catch a case in my first year out of school? Guess I can just ignore it!

> >

> > Well Cogbill, the odds of you hitting one was 100%. The odds of

you identifying it was 0%. The odds of me being in pain for an additional 4

years and never being able to return to work was 100%. Yes, I ended up with LVH

and required oxygen for 1 ½ years. Yes, OSA worsened. Yes, I ended up with T2DM

and COPD. Suggest you review current info on PA and find it affects ~10% of the

people with HTN! (God, I wish I knew where she is today just to give her the

final chapter. She got closer than anyone else!) Never mind, I do know where the

supervising doctor is and maybe I will point this out to him, no reason to waste

good research!

> >

> > Aren't complete electronic medical records great. Sure is easy to be a

" Monday Morning Quarterback " ! That is not my goal but I do hope to show them how

close they were and maybe they will take that last step next time! We

sometimes need to " think outside the box " !

> >

> >

>

[Guest guest]

You can go to myhealthevet and go to Prescription Refill History an see what

meds you got from the VA and the dates given.

> >

> > > I did little detective work and think I have a handle on my K issues (lab

range = 3.5-5.0). When I started (8/3/05) it was 3.9 and two other readings

before 7/12/06 were 3.8 and 3.7. Two weeks later, 7/12/06, it was 3.3! They must

have decided something was amiss because they took two more readings before

adding K supplements on 11/17/06, both readings = 3.2.

> > >

> > > The lead doctor for that team got involved on 8/7/06 and ordered a 24hr

urine test for Cortisol Free, results = 35.5 (range 4.0-50.0) Guess I passed!

Hmmm wait minute, volume was 1950. Didn't I hear over 1500 was suspect for

something? PA maybe? Never mind, his Cortisol was ok!

> > >

> > > I must have still complained because they " fixed the problem " in November

by adding the K supplements. Wait a minute, maybe that didn't fix it - PTN is

back on 2/7/07 and K = 3.5. 2 week recall it =3.6. I don't recognize the doctor,

she was probably in immediate care, but she ordered renin and aldo. Results,

renin=0.1 and aldo = 5 and a ct-scan showed a 12mmX13mm adenoma in the right

adrenal. With aldo in range she must have assumed the rest could be ignored

because that is exactly what happened for the next 3 ½ years!

> > >

> > > Wait a minute , look at that lab report again. What does

" Low-renin sodium/volume-mediated hypertension likely: <0.65 " and " Primary

aldosteronsim possible: <0.65 " mean? Maybe they went over that the day I went

skiing! What is this PA crap, that's Conn's isn't it? It's so rare, what are the

odds that I would catch a case in my first year out of school? Guess I can just

ignore it!

> > >

> > > Well Cogbill, the odds of you hitting one was 100%. The odds of

you identifying it was 0%. The odds of me being in pain for an additional 4

years and never being able to return to work was 100%. Yes, I ended up with LVH

and required oxygen for 1 ½ years. Yes, OSA worsened. Yes, I ended up with T2DM

and COPD. Suggest you review current info on PA and find it affects ~10% of the

people with HTN! (God, I wish I knew where she is today just to give her the

final chapter. She got closer than anyone else!) Never mind, I do know where the

supervising doctor is and maybe I will point this out to him, no reason to waste

good research!

> > >

> > > Aren't complete electronic medical records great. Sure is easy to be a

" Monday Morning Quarterback " ! That is not my goal but I do hope to show them how

close they were and maybe they will take that last step next time! We

sometimes need to " think outside the box " !

> > >

> > >

> >

>