Re: Post Adrenalectomy Medications

[Guest guest]

Eating too much salt is one cause most likely. When was bystolic started? Any other meds for anything.Don't see thumbnail so forget the details. My first guess is that the PA is back.Do you have a copy of the path report from your surgery.Need more details. CE Grim MDOn Apr 17, 2012, at 7:25 PM, lk.barns wrote: I've seen Dr. Grim post several times that BB's and CCB's are not the best BP meds for PA. Does this apply to post adrenalectomy as well and is spironolactone still an option? In looking through the files I was unable to locate the appropriate file or study containing this info. I'm returning to my cardiologist on Thursday and was looking for information to share regarding the best medications for my condition keeping in mind that I also have other heart issues. (CABG & LBBB) My systolic BP has been creeping up steadily over the last three weeks and my dystolic has been creeping down. I have also begun to retain fluid which may account for the BP changes. Lab test 2.5 weeks ago showed normal K (mid-range), low NA and low magnesium. Brief Summary Average BP & HR 3 weeks ago 118/78 HR 75 Average BP & HR last 7 days 130/64 HR 82 Lab results (don't have numbers) K - normal in Mid-range Na - Below normal range Magnesium - Below normal range Aldosterone - within Normal range Retaining fluid past 7 days - Swollen feet and legs up 6 lbs MEDICATIONS 2.5 Bystolic .25 Digoxin 40 mg Lasix

[Guest guest]

So I would DASH like my life and ankles depended on it. Have CARDs check your urine Na, K, creat, albumin in a sample to estimate how you are DASHing now.CE Grim MDOn Apr 17, 2012, at 7:25 PM, lk.barns wrote: I've seen Dr. Grim post several times that BB's and CCB's are not the best BP meds for PA. Does this apply to post adrenalectomy as well and is spironolactone still an option? In looking through the files I was unable to locate the appropriate file or study containing this info. I'm returning to my cardiologist on Thursday and was looking for information to share regarding the best medications for my condition keeping in mind that I also have other heart issues. (CABG & LBBB) My systolic BP has been creeping up steadily over the last three weeks and my dystolic has been creeping down. I have also begun to retain fluid which may account for the BP changes. Lab test 2.5 weeks ago showed normal K (mid-range), low NA and low magnesium. Brief Summary Average BP & HR 3 weeks ago 118/78 HR 75 Average BP & HR last 7 days 130/64 HR 82 Lab results (don't have numbers) K - normal in Mid-range Na - Below normal range Magnesium - Below normal range Aldosterone - within Normal range Retaining fluid past 7 days - Swollen feet and legs up 6 lbs MEDICATIONS 2.5 Bystolic .25 Digoxin 40 mg Lasix

[Guest guest]

Kind of an odd question. If it's Post-adrenalectomy why would you need either one (I know there's some catch-up time after surgery)? The whole idea behind yanking your adrenal gland is to stop the hyperaldosteronism (or whatever the issue was). If you have the same high blood pressure after then it wasn't pa and you just lost an adrenal gland...or it still is and they got the wrong one. Hopefully pulling the adrenal solves the problem and you feel better, and you can exercise better and get healthier. And I am sure you are/were already eating as best you can to try and solve the issue on your own before surgery.

And Dr G is mainly referring to those medication classes in regards to PA because they are mostly ineffective in that case. Many of us (most maybe?) also have shown evidence of LVH (enlarged left side heart) because of our hypertension being untreated/misdaignosed/ignored for so long .....pick the reason.....but that is recoverable once we control the HTN - usually. Post MI, the BB and ACEI (like lisinopril) show good benefit in remodeling the heart after a heart attack, but spiro has shown, with very good studies, to reduce LVH in those with PA (and some without) when they use it.

But here's my take on it.........I so far am a good example as I haven't taken my spiro - except for a couple days last week when I was sick and my BP spiked - for over a month because it was doing great on DASHing and exercise. I am by no means a fanatic for either one and not perfect in either one as I am way too aloof to ever be obsessed over anything, but I am putting in effort and it's really paid off (I am only 44 years old with 7 kiddos and a crazy, but beautiful, red-headed wife ). My story in a nutshell is for many years (2002/2003 was maybe the first inkling of something wrong) and hospital stays, maybe a hundred office/er all total visits over those years and always misdiagnosed/ignored/missed the PA. BP back then was easily 160/120 plus daily for years even on 5 meds sometimes.

After two doses of spiro on a cardiologists hunch (I was 184/140 in his office and HE took it over and over and I was on 5 meds that day) I had the very first normal BP in over 5 years (that was in 11/2010). The misdiagnoses and especially the chronic low K caused ALOT of problems that built up over the years, and has nearly ruined me professionally, did ruin us financially (long long story), but I am healthy. I never dashed until I found this site and did as Dr G and everyone suggested (I should have known better but I didn't) and went from 50mg to 25mg to 12.5 mg to nothing. I do still take my K as that part of my diet is the weakest, but I do feel a difference between natural K and the pills.

Now I had tests done, but never was one ever done right (they never took me off any meds), and I never had any AVS. My CT did not show anything on my adrenals (can't say I fully trust it, but it is what it is for now - if I come up with the cash I will have Dr G review all my stuff). Endocrine did not want to take me off of the spiro after it worked so well, and said he wouldn't consider me a surgery candidate anyway with the unstable pressure off of it (and I had thyroid trouble too), and so I just worked my butt off. I have some other health issues, but dealing with those as we go.

Oh yeah...I tend to ramble a bit, so I aologize, but I meant to say also that at my last echo a year ago at least, the LVH I had was gone. So hopefully you have taken control and DASH and exercise and get off those meds if you can .....and fix that ticker too. You can do it!

I've seen Dr. Grim post several times that BB's and CCB's are not the best BP meds for PA. Does this apply to post adrenalectomy as well and is spironolactone still an option? In looking through the files I was unable to locate the appropriate file or study containing this info.I'm returning to my cardiologist on Thursday and was looking for information to share regarding the best medications for my condition keeping in mind that I also have other heart issues. (CABG & LBBB) My systolic BP has been creeping up steadily over the last three weeks and my dystolic has been creeping down. I have also begun to retain fluid which may account for the BP changes. Lab test 2.5 weeks ago showed normal K (mid-range), low NA and low magnesium.Brief Summary Average BP & HR 3 weeks ago118/78 HR 75Average BP & HR last 7 days 130/64 HR 82Lab results (don't have numbers)K - normal in Mid-rangeNa

- Below normal rangeMagnesium - Below normal rangeAldosterone - within Normal rangeRetaining fluid past 7 days - Swollen feet and legs up 6 lbsMEDICATIONS2.5 Bystolic.25 Digoxin40 mg Lasix

[Guest guest]

I suggest rather than spending a lot of time playing " what ifs " you work with

your Card and do proper testing and logical analysis to determine what is going

on. I would think renin might be a good place to start since we know it is

usually surpressed in PA. If it is still surpressed may need to retest for PA

but it may also be a factor of time. How long since ADx? I've read where it

might take up to a year. Renin will also tell you whether your " A " meds (ACE &

ARB) will work since we all know the " A " starts with renin (atleast that is what

my Hypertension Primer tells me!)

You might look in our files. If I remember correctly there is a file by

Stowasser etal that does a good job detailing the followup process. (I haven't

reviewed it recently since I now rely on the Moraitis method - that's Dr.

Moraitis at NIH, god he's good!)

>

> I've seen Dr. Grim post several times that BB's and CCB's are not the best BP

meds for PA. Does this apply to post adrenalectomy as well and is spironolactone

still an option? In looking through the files I was unable to locate the

appropriate file or study containing this info.

> I'm returning to my cardiologist on Thursday and was looking for information

to share regarding the best medications for my condition keeping in mind that I

also have other heart issues. (CABG & LBBB) My systolic BP has been creeping up

steadily over the last three weeks and my dystolic has been creeping down. I

have also begun to retain fluid which may account for the BP changes. Lab test

2.5 weeks ago showed normal K (mid-range), low NA and low magnesium.

>

> Brief Summary

>

> Average BP & HR 3 weeks ago

> 118/78 HR 75

>

> Average BP & HR last 7 days

> 130/64 HR 82

>

> Lab results (don't have numbers)

>

> K - normal in Mid-range

>

> Na - Below normal range

>

> Magnesium - Below normal range

>

> Aldosterone - within Normal range

>

> Retaining fluid past 7 days - Swollen feet and legs up 6 lbs

>

> MEDICATIONS

> 2.5 Bystolic

> .25 Digoxin

> 40 mg Lasix

>

[Guest guest]

Even with my urine sodium " too low to quantitate, " my ankles remained swollen until I got Lyme disease treatment. Now they're normal and I'm eating quite a bit more salt. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Clarence GrimEating too much salt is one cause most likely.On Apr 17, 2012, at 7:25 PM, lk.barns wrote:I have also begun to retain fluid which may account for the BP changes. Lab test 2.5 weeks ago showed normal K (mid-range), low NA and low magnesium.

[Guest guest]

Yes the adrenalectomy does seem to have solved most of the problems and I am

probably trying to rush things a bit. I just walked in from work and I don't

feel like I've been hit by a truck. My strength and endurance are increasing

daily - mentally and physically, I feel better than I have in ten years.

Looking forward to starting an exercise program in the next few weeks once I can

get through the day fairly easily. Will start out with walking and yoga - add

strength training a few weeks later after my balance improves and swimming this

summer. Who knows maybe this time next year I'll be dashing rather than

DASHing.

Had 4 heart grafts in 2010 and was progressing well in cardiac rehab until the

adrenal adenoma that all the doctors assured me was not causing me any problems

knocked me for a loop. My physical symptoms were well documented as I struggled

through the last 2 weeks of rehab. The adenoma was discovered in 2001 - however

none of my labs were ever interpreted as cause for further study despite

repeatedly being told to take potassium because my numbers were too low. Then

in January the serum aldosterone was too high to ignore.

I have a LBBB - left bundle branch block - that has appeared on every EKG back

to my early 20's. I also have PVCs and LVH - although the LVH has improved

according to my Echo in February. During a time in 2010 while I was having no

physical symptoms, I sailed though a stress test. So I have no doubt that my

heart can be reconditioned and allow me to live a relatively normal life now

that the adrenal problem seems to be corrected. The path report indicated a 1.6

cm hyperplasic nodule - no other nodules or hyperplasic areas in the rest of the

adrenal. Hopefully this shows that this was just a fluke and the other adrenal

will cooperate with me.

I guess that I am feeling so well that want it all. As you may know from being

married to a red head, we can be an impatient lot. However since I turn 50 this

year my " plantinum " hilights are beginning to crowd out the red.

[Guest guest]

Still DASHING and DASHING. Path report showed a single 1.6

cm hyperplasic nodule - no other nodules or hyperplasic areas in the rest of the

adrenal.

Only other med is 120 mg of Cymbalta

also have 4 cardiac grafts, LVH, LBBB and PVCs

I'm probably just impatient since I feel so well but surgery was only 3.5 months

ago

> > Brief Summary

> >

> > Average BP & HR 3 weeks ago

> > 118/78 HR 75

> >

> > Average BP & HR last 7 days

> > 130/64 HR 82

> >

> > Lab results (don't have numbers)

> >

> > K - normal in Mid-range

> >

> > Na - Below normal range

> >

> > Magnesium - Below normal range

> >

> > Aldosterone - within Normal range

> >

> > Retaining fluid past 7 days - Swollen feet and legs up 6 lbs

> >

> > MEDICATIONS

> > 2.5 Bystolic

> > .25 Digoxin

> > 40 mg Lasix

> >

> >

>

[Guest guest]

Thanks - these tests will be done Thursday.

You're right the two worst games we can play are " what if " and " could-a,

would-a, should-a "

[Guest guest]

AWESOME. I dont think weve ever had to many "bad" stories regardless of age after surgery.

From: lk.barns <lk.barns@...>Subject: Re: Post Adrenalectomy Medicationshyperaldosteronism Date: Wednesday, April 18, 2012, 7:10 PM

Yes the adrenalectomy does seem to have solved most of the problems and I am probably trying to rush things a bit. I just walked in from work and I don't feel like I've been hit by a truck. My strength and endurance are increasing daily - mentally and physically, I feel better than I have in ten years. Looking forward to starting an exercise program in the next few weeks once I can get through the day fairly easily. Will start out with walking and yoga - add strength training a few weeks later after my balance improves and swimming this summer. Who knows maybe this time next year I'll be dashing rather than DASHing.Had 4 heart grafts in 2010 and was progressing well in cardiac rehab until the adrenal adenoma that all the doctors assured me was not causing me any problems knocked me for a loop. My physical symptoms were well documented as I struggled through the last 2 weeks of rehab. The adenoma was discovered in 2001 - however none of my

labs were ever interpreted as cause for further study despite repeatedly being told to take potassium because my numbers were too low. Then in January the serum aldosterone was too high to ignore. I have a LBBB - left bundle branch block - that has appeared on every EKG back to my early 20's. I also have PVCs and LVH - although the LVH has improved according to my Echo in February. During a time in 2010 while I was having no physical symptoms, I sailed though a stress test. So I have no doubt that my heart can be reconditioned and allow me to live a relatively normal life now that the adrenal problem seems to be corrected. The path report indicated a 1.6 cm hyperplasic nodule - no other nodules or hyperplasic areas in the rest of the adrenal. Hopefully this shows that this was just a fluke and the other adrenal will cooperate with me.I guess that I am feeling so well that want it all. As you may know from being married to a red head, we

can be an impatient lot. However since I turn 50 this year my "plantinum" hilights are beginning to crowd out the red.

[Guest guest]

L VH and pvcs should be getting better as Bp and k improve. Keep us posted. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Apr 18, 2012, at 19:16, "lk.barns" <lk.barns@...> wrote:

Still DASHING and DASHING. Path report showed a single 1.6

cm hyperplasic nodule - no other nodules or hyperplasic areas in the rest of the adrenal.

Only other med is 120 mg of Cymbalta

also have 4 cardiac grafts, LVH, LBBB and PVCs

I'm probably just impatient since I feel so well but surgery was only 3.5 months ago

> > Brief Summary

> >

> > Average BP & HR 3 weeks ago

> > 118/78 HR 75

> >

> > Average BP & HR last 7 days

> > 130/64 HR 82

> >

> > Lab results (don't have numbers)

> >

> > K - normal in Mid-range

> >

> > Na - Below normal range

> >

> > Magnesium - Below normal range

> >

> > Aldosterone - within Normal range

> >

> > Retaining fluid past 7 days - Swollen feet and legs up 6 lbs

> >

> > MEDICATIONS

> > 2.5 Bystolic

> > .25 Digoxin

> > 40 mg Lasix

> >

> >

>

[Guest guest]

No sure what the term hyper plastic nodule means. Hyperplasia means more than one usually. Can u send report?May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Apr 18, 2012, at 19:10, "lk.barns" <lk.barns@...> wrote:

Yes the adrenalectomy does seem to have solved most of the problems and I am probably trying to rush things a bit. I just walked in from work and I don't feel like I've been hit by a truck. My strength and endurance are increasing daily - mentally and physically, I feel better than I have in ten years. Looking forward to starting an exercise program in the next few weeks once I can get through the day fairly easily. Will start out with walking and yoga - add strength training a few weeks later after my balance improves and swimming this summer. Who knows maybe this time next year I'll be dashing rather than DASHing.

Had 4 heart grafts in 2010 and was progressing well in cardiac rehab until the adrenal adenoma that all the doctors assured me was not causing me any problems knocked me for a loop. My physical symptoms were well documented as I struggled through the last 2 weeks of rehab. The adenoma was discovered in 2001 - however none of my labs were ever interpreted as cause for further study despite repeatedly being told to take potassium because my numbers were too low. Then in January the serum aldosterone was too high to ignore.

I have a LBBB - left bundle branch block - that has appeared on every EKG back to my early 20's. I also have PVCs and LVH - although the LVH has improved according to my Echo in February. During a time in 2010 while I was having no physical symptoms, I sailed though a stress test. So I have no doubt that my heart can be reconditioned and allow me to live a relatively normal life now that the adrenal problem seems to be corrected. The path report indicated a 1.6 cm hyperplasic nodule - no other nodules or hyperplasic areas in the rest of the adrenal. Hopefully this shows that this was just a fluke and the other adrenal will cooperate with me.

I guess that I am feeling so well that want it all. As you may know from being married to a red head, we can be an impatient lot. However since I turn 50 this year my "plantinum" hilights are beginning to crowd out the red.

[Guest guest]

Take my ehEvolition article to all who missed you.May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Apr 18, 2012, at 19:10, "lk.barns" <lk.barns@...> wrote:

Yes the adrenalectomy does seem to have solved most of the problems and I am probably trying to rush things a bit. I just walked in from work and I don't feel like I've been hit by a truck. My strength and endurance are increasing daily - mentally and physically, I feel better than I have in ten years. Looking forward to starting an exercise program in the next few weeks once I can get through the day fairly easily. Will start out with walking and yoga - add strength training a few weeks later after my balance improves and swimming this summer. Who knows maybe this time next year I'll be dashing rather than DASHing.

Had 4 heart grafts in 2010 and was progressing well in cardiac rehab until the adrenal adenoma that all the doctors assured me was not causing me any problems knocked me for a loop. My physical symptoms were well documented as I struggled through the last 2 weeks of rehab. The adenoma was discovered in 2001 - however none of my labs were ever interpreted as cause for further study despite repeatedly being told to take potassium because my numbers were too low. Then in January the serum aldosterone was too high to ignore.

I have a LBBB - left bundle branch block - that has appeared on every EKG back to my early 20's. I also have PVCs and LVH - although the LVH has improved according to my Echo in February. During a time in 2010 while I was having no physical symptoms, I sailed though a stress test. So I have no doubt that my heart can be reconditioned and allow me to live a relatively normal life now that the adrenal problem seems to be corrected. The path report indicated a 1.6 cm hyperplasic nodule - no other nodules or hyperplasic areas in the rest of the adrenal. Hopefully this shows that this was just a fluke and the other adrenal will cooperate with me.

I guess that I am feeling so well that want it all. As you may know from being married to a red head, we can be an impatient lot. However since I turn 50 this year my "plantinum" hilights are beginning to crowd out the red.

[Guest guest]

, can I add a " HOLY CRAP " to your response! It looks like great advances

are being made! And if we could bottle that attitude and give out doses of it

we would all be better off!

>

>

> From: lk.barns <lk.barns@...>

> Subject: Re: Post Adrenalectomy Medications

> hyperaldosteronism

> Date: Wednesday, April 18, 2012, 7:10 PM

>

>

>

>  

>

>

>

> Yes the adrenalectomy does seem to have solved most of the problems and I am

probably trying to rush things a bit. I just walked in from work and I don't

feel like I've been hit by a truck. My strength and endurance are increasing

daily - mentally and physically, I feel better than I have in ten years. Looking

forward to starting an exercise program in the next few weeks once I can get

through the day fairly easily. Will start out with walking and yoga - add

strength training a few weeks later after my balance improves and swimming this

summer. Who knows maybe this time next year I'll be dashing rather than DASHing.

>

> Had 4 heart grafts in 2010 and was progressing well in cardiac rehab until the

adrenal adenoma that all the doctors assured me was not causing me any problems

knocked me for a loop. My physical symptoms were well documented as I struggled

through the last 2 weeks of rehab. The adenoma was discovered in 2001 - however

none of my labs were ever interpreted as cause for further study despite

repeatedly being told to take potassium because my numbers were too low. Then in

January the serum aldosterone was too high to ignore.

>

> I have a LBBB - left bundle branch block - that has appeared on every EKG back

to my early 20's. I also have PVCs and LVH - although the LVH has improved

according to my Echo in February. During a time in 2010 while I was having no

physical symptoms, I sailed though a stress test. So I have no doubt that my

heart can be reconditioned and allow me to live a relatively normal life now

that the adrenal problem seems to be corrected. The path report indicated a 1.6

cm hyperplasic nodule - no other nodules or hyperplasic areas in the rest of the

adrenal. Hopefully this shows that this was just a fluke and the other adrenal

will cooperate with me.

>

> I guess that I am feeling so well that want it all. As you may know from being

married to a red head, we can be an impatient lot. However since I turn 50 this

year my " plantinum " hilights are beginning to crowd out the red.

>

[Guest guest]

Dr. Grimm - If your not sure what it means, this is surely above my pay grade.

Don't have a copy of the report but this is what I wrote down as the

pathologists opinion when we reviewed the report.

>

> > Yes the adrenalectomy does seem to have solved most of the problems and I am

probably trying to rush things a bit. I just walked in from work and I don't

feel like I've been hit by a truck. My strength and endurance are increasing

daily - mentally and physically, I feel better than I have in ten years. Looking

forward to starting an exercise program in the next few weeks once I can get

through the day fairly easily. Will start out with walking and yoga - add

strength training a few weeks later after my balance improves and swimming this

summer. Who knows maybe this time next year I'll be dashing rather than DASHing.

> >

> > Had 4 heart grafts in 2010 and was progressing well in cardiac rehab until

the adrenal adenoma that all the doctors assured me was not causing me any

problems knocked me for a loop. My physical symptoms were well documented as I

struggled through the last 2 weeks of rehab. The adenoma was discovered in 2001

- however none of my labs were ever interpreted as cause for further study

despite repeatedly being told to take potassium because my numbers were too low.

Then in January the serum aldosterone was too high to ignore.

> >

> > I have a LBBB - left bundle branch block - that has appeared on every EKG

back to my early 20's. I also have PVCs and LVH - although the LVH has improved

according to my Echo in February. During a time in 2010 while I was having no

physical symptoms, I sailed though a stress test. So I have no doubt that my

heart can be reconditioned and allow me to live a relatively normal life now

that the adrenal problem seems to be corrected. The path report indicated a 1.6

cm hyperplasic nodule - no other nodules or hyperplasic areas in the rest of the

adrenal. Hopefully this shows that this was just a fluke and the other adrenal

will cooperate with me.

> >

> > I guess that I am feeling so well that want it all. As you may know from

being married to a red head, we can be an impatient lot. However since I turn 50

this year my " plantinum " hilights are beginning to crowd out the red.

> >

> >

>

[Guest guest]

OK so I was pretty much told to cool my jets and that before we start changing

anything I need to settle into my " new normal " . Cardio also felt that the

slight increase in BP and HR were related to fluid retention. He said " you're

puffy " and instructed me to adjust my lasix as needed to keep the fluid down.

Had been doing this prior to surgery but was hesitant to do it now that things

have changed. I've been here before and I guess I keep waiting for the other

shoe to drop. Was given the OK to start exercise which as my tolerance

increases will also help stabilize BP, HR & fluid. So for now I'll be a bit more

patient, remember I'm less than a month out of surgery, and stop looking for

flying shoes.

> >

> >

> > From: lk.barns <lk.barns@>

> > Subject: Re: Post Adrenalectomy Medications

> > hyperaldosteronism

> > Date: Wednesday, April 18, 2012, 7:10 PM

> >

> >

> >

> >  

> >

> >

> >

> > Yes the adrenalectomy does seem to have solved most of the problems and I am

probably trying to rush things a bit. I just walked in from work and I don't

feel like I've been hit by a truck. My strength and endurance are increasing

daily - mentally and physically, I feel better than I have in ten years. Looking

forward to starting an exercise program in the next few weeks once I can get

through the day fairly easily. Will start out with walking and yoga - add

strength training a few weeks later after my balance improves and swimming this

summer. Who knows maybe this time next year I'll be dashing rather than DASHing.

> >

> > Had 4 heart grafts in 2010 and was progressing well in cardiac rehab until

the adrenal adenoma that all the doctors assured me was not causing me any

problems knocked me for a loop. My physical symptoms were well documented as I

struggled through the last 2 weeks of rehab. The adenoma was discovered in 2001

- however none of my labs were ever interpreted as cause for further study

despite repeatedly being told to take potassium because my numbers were too low.

Then in January the serum aldosterone was too high to ignore.

> >

> > I have a LBBB - left bundle branch block - that has appeared on every EKG

back to my early 20's. I also have PVCs and LVH - although the LVH has improved

according to my Echo in February. During a time in 2010 while I was having no

physical symptoms, I sailed though a stress test. So I have no doubt that my

heart can be reconditioned and allow me to live a relatively normal life now

that the adrenal problem seems to be corrected. The path report indicated a 1.6

cm hyperplasic nodule - no other nodules or hyperplasic areas in the rest of the

adrenal. Hopefully this shows that this was just a fluke and the other adrenal

will cooperate with me.

> >

> > I guess that I am feeling so well that want it all. As you may know from

being married to a red head, we can be an impatient lot. However since I turn 50

this year my " plantinum " hilights are beginning to crowd out the red.

> >

>

[Guest guest]

A MONTH??? I change my comment to HOLY HOLY CRAP! You've got a smart Cardio!

> > >

> > >

> > > From: lk.barns <lk.barns@>

> > > Subject: Re: Post Adrenalectomy Medications

> > > hyperaldosteronism

> > > Date: Wednesday, April 18, 2012, 7:10 PM

> > >

> > >

> > >

> > >  

> > >

> > >

> > >

> > > Yes the adrenalectomy does seem to have solved most of the problems and I

am probably trying to rush things a bit. I just walked in from work and I don't

feel like I've been hit by a truck. My strength and endurance are increasing

daily - mentally and physically, I feel better than I have in ten years. Looking

forward to starting an exercise program in the next few weeks once I can get

through the day fairly easily. Will start out with walking and yoga - add

strength training a few weeks later after my balance improves and swimming this

summer. Who knows maybe this time next year I'll be dashing rather than DASHing.

> > >

> > > Had 4 heart grafts in 2010 and was progressing well in cardiac rehab until

the adrenal adenoma that all the doctors assured me was not causing me any

problems knocked me for a loop. My physical symptoms were well documented as I

struggled through the last 2 weeks of rehab. The adenoma was discovered in 2001

- however none of my labs were ever interpreted as cause for further study

despite repeatedly being told to take potassium because my numbers were too low.

Then in January the serum aldosterone was too high to ignore.

> > >

> > > I have a LBBB - left bundle branch block - that has appeared on every EKG

back to my early 20's. I also have PVCs and LVH - although the LVH has improved

according to my Echo in February. During a time in 2010 while I was having no

physical symptoms, I sailed though a stress test. So I have no doubt that my

heart can be reconditioned and allow me to live a relatively normal life now

that the adrenal problem seems to be corrected. The path report indicated a 1.6

cm hyperplasic nodule - no other nodules or hyperplasic areas in the rest of the

adrenal. Hopefully this shows that this was just a fluke and the other adrenal

will cooperate with me.

> > >

> > > I guess that I am feeling so well that want it all. As you may know from

being married to a red head, we can be an impatient lot. However since I turn 50

this year my " plantinum " hilights are beginning to crowd out the red.

> > >

> >

>

[Guest guest]

Yep a month - He was the one who was pushing me to keep trying to get the

answers - knew this was the problem but could never get the numbers - he's also

the one that started me on Spiro.

The kicker - His mother was my 8th grade history teacher and was pregnant with

him at the time - Love him love his mom - Why else would I let him get away with

looking at me and saying " you're puffy " !

> > > >

> > > >

> > > > From: lk.barns <lk.barns@>

> > > > Subject: Re: Post Adrenalectomy Medications

> > > > hyperaldosteronism

> > > > Date: Wednesday, April 18, 2012, 7:10 PM

> > > >

> > > >

> > > >

> > > >  

> > > >

> > > >

> > > >

> > > > Yes the adrenalectomy does seem to have solved most of the problems and

I am probably trying to rush things a bit. I just walked in from work and I

don't feel like I've been hit by a truck. My strength and endurance are

increasing daily - mentally and physically, I feel better than I have in ten

years. Looking forward to starting an exercise program in the next few weeks

once I can get through the day fairly easily. Will start out with walking and

yoga - add strength training a few weeks later after my balance improves and

swimming this summer. Who knows maybe this time next year I'll be dashing rather

than DASHing.

> > > >

> > > > Had 4 heart grafts in 2010 and was progressing well in cardiac rehab

until the adrenal adenoma that all the doctors assured me was not causing me any

problems knocked me for a loop. My physical symptoms were well documented as I

struggled through the last 2 weeks of rehab. The adenoma was discovered in 2001

- however none of my labs were ever interpreted as cause for further study

despite repeatedly being told to take potassium because my numbers were too low.

Then in January the serum aldosterone was too high to ignore.

> > > >

> > > > I have a LBBB - left bundle branch block - that has appeared on every

EKG back to my early 20's. I also have PVCs and LVH - although the LVH has

improved according to my Echo in February. During a time in 2010 while I was

having no physical symptoms, I sailed though a stress test. So I have no doubt

that my heart can be reconditioned and allow me to live a relatively normal life

now that the adrenal problem seems to be corrected. The path report indicated a

1.6 cm hyperplasic nodule - no other nodules or hyperplasic areas in the rest of

the adrenal. Hopefully this shows that this was just a fluke and the other

adrenal will cooperate with me.

> > > >

> > > > I guess that I am feeling so well that want it all. As you may know from

being married to a red head, we can be an impatient lot. However since I turn 50

this year my " plantinum " hilights are beginning to crowd out the red.

> > > >

> > >

> >

>

[Guest guest]

Wait a minute, define " Puffy " ! " Puffy " where? What was your renin and aldo

prior to surgery and were you on any meds when it was measured?

> > > > >

> > > > >

> > > > > From: lk.barns <lk.barns@>

> > > > > Subject: Re: Post Adrenalectomy Medications

> > > > > hyperaldosteronism

> > > > > Date: Wednesday, April 18, 2012, 7:10 PM

> > > > >

> > > > >

> > > > >

> > > > >  

> > > > >

> > > > >

> > > > >

> > > > > Yes the adrenalectomy does seem to have solved most of the problems

and I am probably trying to rush things a bit. I just walked in from work and I

don't feel like I've been hit by a truck. My strength and endurance are

increasing daily - mentally and physically, I feel better than I have in ten

years. Looking forward to starting an exercise program in the next few weeks

once I can get through the day fairly easily. Will start out with walking and

yoga - add strength training a few weeks later after my balance improves and

swimming this summer. Who knows maybe this time next year I'll be dashing rather

than DASHing.

> > > > >

> > > > > Had 4 heart grafts in 2010 and was progressing well in cardiac rehab

until the adrenal adenoma that all the doctors assured me was not causing me any

problems knocked me for a loop. My physical symptoms were well documented as I

struggled through the last 2 weeks of rehab. The adenoma was discovered in 2001

- however none of my labs were ever interpreted as cause for further study

despite repeatedly being told to take potassium because my numbers were too low.

Then in January the serum aldosterone was too high to ignore.

> > > > >

> > > > > I have a LBBB - left bundle branch block - that has appeared on every

EKG back to my early 20's. I also have PVCs and LVH - although the LVH has

improved according to my Echo in February. During a time in 2010 while I was

having no physical symptoms, I sailed though a stress test. So I have no doubt

that my heart can be reconditioned and allow me to live a relatively normal life

now that the adrenal problem seems to be corrected. The path report indicated a

1.6 cm hyperplasic nodule - no other nodules or hyperplasic areas in the rest of

the adrenal. Hopefully this shows that this was just a fluke and the other

adrenal will cooperate with me.

> > > > >

> > > > > I guess that I am feeling so well that want it all. As you may know

from being married to a red head, we can be an impatient lot. However since I

turn 50 this year my " plantinum " hilights are beginning to crowd out the red.

> > > > >

> > > >

> > >

> >

>

[Guest guest]

Swollen feet up to calves - Swollen hands and forearms - round swollen face.

Don't have my numbers - but no one has ever taken me off meds for testing -

except metformin for scans (have not taken this for a year) Was taking 2.5 mg

bystolic, .25 digoxin & 40 mg lasix at the time of all testing. Was also

prescribed 100 mg spiro but stopped taking it when I found out AVS would be

scheduled - about a week prior to test and when I found out I would have to have

a 2nd AVS also about a week. last tests showed normal range Aldo & renin levels

- below normal range sodium and magnesium levels and normal range K (upper end

of range) - I've always made notes when given results but rarely have written

down numbers just indications where in the range the numbers fell -once things

slow down a bit I plan on getting all the results from the internist & cardio as

between them they have most of the results from all the other doctors I've been

to.

> > > > > >

> > > > > >

> > > > > > From: lk.barns <lk.barns@>

> > > > > > Subject: Re: Post Adrenalectomy Medications

> > > > > > hyperaldosteronism

> > > > > > Date: Wednesday, April 18, 2012, 7:10 PM

> > > > > >

> > > > > >

> > > > > >

> > > > > >  

> > > > > >

> > > > > >

> > > > > >

> > > > > > Yes the adrenalectomy does seem to have solved most of the problems

and I am probably trying to rush things a bit. I just walked in from work and I

don't feel like I've been hit by a truck. My strength and endurance are

increasing daily - mentally and physically, I feel better than I have in ten

years. Looking forward to starting an exercise program in the next few weeks

once I can get through the day fairly easily. Will start out with walking and

yoga - add strength training a few weeks later after my balance improves and

swimming this summer. Who knows maybe this time next year I'll be dashing rather

than DASHing.

> > > > > >

> > > > > > Had 4 heart grafts in 2010 and was progressing well in cardiac rehab

until the adrenal adenoma that all the doctors assured me was not causing me any

problems knocked me for a loop. My physical symptoms were well documented as I

struggled through the last 2 weeks of rehab. The adenoma was discovered in 2001

- however none of my labs were ever interpreted as cause for further study

despite repeatedly being told to take potassium because my numbers were too low.

Then in January the serum aldosterone was too high to ignore.

> > > > > >

> > > > > > I have a LBBB - left bundle branch block - that has appeared on

every EKG back to my early 20's. I also have PVCs and LVH - although the LVH has

improved according to my Echo in February. During a time in 2010 while I was

having no physical symptoms, I sailed though a stress test. So I have no doubt

that my heart can be reconditioned and allow me to live a relatively normal life

now that the adrenal problem seems to be corrected. The path report indicated a

1.6 cm hyperplasic nodule - no other nodules or hyperplasic areas in the rest of

the adrenal. Hopefully this shows that this was just a fluke and the other

adrenal will cooperate with me.

> > > > > >

> > > > > > I guess that I am feeling so well that want it all. As you may know

from being married to a red head, we can be an impatient lot. However since I

turn 50 this year my " plantinum " hilights are beginning to crowd out the red.

> > > > > >

> > > > >

> > > >

> > >

> >

>

[Guest guest]

I think you have the best documented de-evolution of PA we have here with meds and finally DASHing. I recommend we put this together for a care report for some medical journals esp those that go to PAs and NPs.But know you are busy.you can respond to me at my email. lowerbp2@...CE Grim MDOn Apr 18, 2012, at 12:54 AM, Bingham wrote: Kind of an odd question. If it's Post-adrenalectomy why would you need either one (I know there's some catch-up time after surgery)? The whole idea behind yanking your adrenal gland is to stop the hyperaldosteronism (or whatever the issue was). If you have the same high blood pressure after then it wasn't pa and you just lost an adrenal gland...or it still is and they got the wrong one. Hopefully pulling the adrenal solves the problem and you feel better, and you can exercise better and get healthier. And I am sure you are/were already eating as best you can to try and solve the issue on your own before surgery. And Dr G is mainly referring to those medication classes in regards to PA because they are mostly ineffective in that case. Many of us (most maybe?) also have shown evidence of LVH (enlarged left side heart) because of our hypertension being untreated/misdaignosed/ignored for so long .....pick the reason.....but that is recoverable once we control the HTN - usually. Post MI, the BB and ACEI (like lisinopril) show good benefit in remodeling the heart after a heart attack, but spiro has shown, with very good studies, to reduce LVH in those with PA (and some without) when they use it. But here's my take on it.........I so far am a good example as I haven't taken my spiro - except for a couple days last week when I was sick and my BP spiked - for over a month because it was doing great on DASHing and exercise. I am by no means a fanatic for either one and not perfect in either one as I am way too aloof to ever be obsessed over anything, but I am putting in effort and it's really paid off (I am only 44 years old with 7 kiddos and a crazy, but beautiful, red-headed wife ). My story in a nutshell is for many years (2002/2003 was maybe the first inkling of something wrong) and hospital stays, maybe a hundred office/er all total visits over those years and always misdiagnosed/ignored/missed the PA. BP back then was easily 160/120 plus daily for years even on 5 meds sometimes. After two doses of spiro on a cardiologists hunch (I was 184/140 in his office and HE took it over and over and I was on 5 meds that day) I had the very first normal BP in over 5 years (that was in 11/2010). The misdiagnoses and especially the chronic low K caused ALOT of problems that built up over the years, and has nearly ruined me professionally, did ruin us financially (long long story), but I am healthy. I never dashed until I found this site and did as Dr G and everyone suggested (I should have known better but I didn't) and went from 50mg to 25mg to 12.5 mg to nothing. I do still take my K as that part of my diet is the weakest, but I do feel a difference between natural K and the pills. Now I had tests done, but never was one ever done right (they never took me off any meds), and I never had any AVS. My CT did not show anything on my adrenals (can't say I fully trust it, but it is what it is for now - if I come up with the cash I will have Dr G review all my stuff). Endocrine did not want to take me off of the spiro after it worked so well, and said he wouldn't consider me a surgery candidate anyway with the unstable pressure off of it (and I had thyroid trouble too), and so I just worked my butt off. I have some other health issues, but dealing with those as we go. Oh yeah...I tend to ramble a bit, so I aologize, but I meant to say also that at my last echo a year ago at least, the LVH I had was gone. So hopefully you have taken control and DASH and exercise and get off those meds if you can .....and fix that ticker too. You can do it! I've seen Dr. Grim post several times that BB's and CCB's are not the best BP meds for PA. Does this apply to post adrenalectomy as well and is spironolactone still an option? In looking through the files I was unable to locate the appropriate file or study containing this info.I'm returning to my cardiologist on Thursday and was looking for information to share regarding the best medications for my condition keeping in mind that I also have other heart issues. (CABG & LBBB) My systolic BP has been creeping up steadily over the last three weeks and my dystolic has been creeping down. I have also begun to retain fluid which may account for the BP changes. Lab test 2.5 weeks ago showed normal K (mid-range), low NA and low magnesium.Brief Summary Average BP & HR 3 weeks ago118/78 HR 75Average BP & HR last 7 days 130/64 HR 82Lab results (don't have numbers)K - normal in Mid-rangeNa - Below normal rangeMagnesium - Below normal rangeAldosterone - within Normal rangeRetaining fluid past 7 days - Swollen feet and legs up 6 lbsMEDICATIONS2.5 Bystolic.25 Digoxin40 mg Lasix

[Guest guest]

Remember though, and I say this alot, is that we came to conclude (the cardiologist initially, and then the endocrinologist) that I had Conn's based primarily on my history and my reaction immediately to the spiro, but I do not have the classic labs to back it up.

I also have a new endo now that I have not met yet since the old one is no longer taking our insurance. But after the years of serious uncontrolled HTN on as many as 5 meds at once, multiple hospitalizations, and very well documented cases of hypokalemia for years, the spiro finally did the trick and did it dramatically. So as for me being an example in a journal I feel like I do not have labs backing up my diagnosis because while they eventually did them, it was only AFTER we started the spiro, and they kept me on the spiro (and I may have still been on an ACEI too) I believe, and nothing was done right. I had at that time the hyperthyroid complicating things also - (though I had NO changes in any thyroid parameter all through 2011 - but tsh is creeping low now 0.60 and some s/s seem to firing up.)

My CT said nothing but a 1cm cyst on Kidney and adrenals clear - if I trust it.

MGBA scan was clear also.

SO I am not a textbook case. What we do know about my case is:

1. Spiro worked at once over 10-20 meds I had tried or been on over 5-6 years - even over 5 meds I was on at the time I started it.

2. Potassium, I still take, worked wonders physically and emotionally on a personal level and seemed to be the root of all my evils at times (I take mag and vit C and iron also for the unk reason anemia)

3. I do DASH well - BUT nothing fanatical, and the weak link is I am not getting the K from diet like I could. I exercise as much as I can and make even the smallest effort every night to do SOMETHING. I have a graduate certificate in sports psychology that I did just for self-interest, but I also notice and believe in all of us, exercise is so helpful, but not the amount - sometimes its just the tiniest focused effort and our bodies seem to pick up the slack and if we can just do "something" it will help us ten-fold. I can do, broken up in sections, 50 push ups, 5minutes of jumping jacks and a little weight lifting and I feel incredible.

4. In 2008 I had significant LVH according to Dr Brogan of the Lubbock Heart Institute and spent time in the hospital in Lubbock as his guest. All heart studies done and all was well except LVH and I still was sent home severely HTN and low K.

5. Last echo, late 2010 the doc said no LVH and everything was perfect - though this cardiologist had a mental breakdown my very next visit (long story) and I believe he's since had some "special" care for mental health according to his receptionsist

So I am not a picture perfect case. There has to be someone where good labs were done, adenomas found, and so on. I have none of that to date.

-- On Sat, 4/21/12, Clarence Grim <lowerbp2@...> wrote:

From: Clarence Grim <lowerbp2@...>Subject: Re: Post Adrenalectomy Medicationshyperaldosteronism Cc: "Clarence Grim" <lowerbp2@...>Date: Saturday, April 21, 2012, 11:39 AM

I think you have the best documented de-evolution of PA we have here with meds and finally DASHing. I recommend we put this together for a care report for some medical journals esp those that go to PAs and NPs.

But know you are busy.

you can respond to me at my email. lowerbp2@...

CE Grim MD

On Apr 18, 2012, at 12:54 AM, Bingham wrote:

Kind of an odd question. If it's Post-adrenalectomy why would you need either one (I know there's some catch-up time after surgery)? The whole idea behind yanking your adrenal gland is to stop the hyperaldosteronism (or whatever the issue was). If you have the same high blood pressure after then it wasn't pa and you just lost an adrenal gland...or it still is and they got the wrong one. Hopefully pulling the adrenal solves the problem and you feel better, and you can exercise better and get healthier. And I am sure you are/were already eating as best you can to try and solve the issue on your own before surgery.

And Dr G is mainly referring to those medication classes in regards to PA because they are mostly ineffective in that case. Many of us (most maybe?) also have shown evidence of LVH (enlarged left side heart) because of our hypertension being untreated/misdaignosed/ignored for so long .....pick the reason.....but that is recoverable once we control the HTN - usually. Post MI, the BB and ACEI (like lisinopril) show good benefit in remodeling the heart after a heart attack, but spiro has shown, with very good studies, to reduce LVH in those with PA (and some without) when they use it.

But here's my take on it.........I so far am a good example as I haven't taken my spiro - except for a couple days last week when I was sick and my BP spiked - for over a month because it was doing great on DASHing and exercise. I am by no means a fanatic for either one and not perfect in either one as I am way too aloof to ever be obsessed over anything, but I am putting in effort and it's really paid off (I am only 44 years old with 7 kiddos and a crazy, but beautiful, red-headed wife ). My story in a nutshell is for many years (2002/2003 was maybe the first inkling of something wrong) and hospital stays, maybe a hundred office/er all total visits over those years and always misdiagnosed/ignored/missed the PA. BP back then was easily 160/120 plus daily for years even on 5 meds sometimes.

After two doses of spiro on a cardiologists hunch (I was 184/140 in his office and HE took it over and over and I was on 5 meds that day) I had the very first normal BP in over 5 years (that was in 11/2010). The misdiagnoses and especially the chronic low K caused ALOT of problems that built up over the years, and has nearly ruined me professionally, did ruin us financially (long long story), but I am healthy. I never dashed until I found this site and did as Dr G and everyone suggested (I should have known better but I didn't) and went from 50mg to 25mg to 12.5 mg to nothing. I do still take my K as that part of my diet is the weakest, but I do feel a difference between natural K and the pills.

Now I had tests done, but never was one ever done right (they never took me off any meds), and I never had any AVS. My CT did not show anything on my adrenals (can't say I fully trust it, but it is what it is for now - if I come up with the cash I will have Dr G review all my stuff). Endocrine did not want to take me off of the spiro after it worked so well, and said he wouldn't consider me a surgery candidate anyway with the unstable pressure off of it (and I had thyroid trouble too), and so I just worked my butt off. I have some other health issues, but dealing with those as we go.

Oh yeah...I tend to ramble a bit, so I aologize, but I meant to say also that at my last echo a year ago at least, the LVH I had was gone. So hopefully you have taken control and DASH and exercise and get off those meds if you can .....and fix that ticker too. You can do it!

I've seen Dr. Grim post several times that BB's and CCB's are not the best BP meds for PA. Does this apply to post adrenalectomy as well and is spironolactone still an option? In looking through the files I was unable to locate the appropriate file or study containing this info.I'm returning to my cardiologist on Thursday and was looking for information to share regarding the best medications for my condition keeping in mind that I also have other heart issues. (CABG & LBBB) My systolic BP has been creeping up steadily over the last three weeks and my dystolic has been creeping down. I have also begun to retain fluid which may account for the BP changes. Lab test 2.5 weeks ago showed normal K (mid-range), low NA and low magnesium.Brief Summary Average BP & HR 3 weeks ago118/78 HR 75Average BP & HR last 7 days 130/64 HR 82Lab results (don't have numbers)K - normal in Mid-rangeNa

- Below normal rangeMagnesium - Below normal rangeAldosterone - within Normal rangeRetaining fluid past 7 days - Swollen feet and legs up 6 lbsMEDICATIONS2.5 Bystolic.25 Digoxin40 mg Lasix

[Guest guest]

Best labs? My mantra...NIH!!!

>

>

>  

>

> I've seen Dr. Grim post several times that BB's and CCB's are not the best BP

meds for PA. Does this apply to post adrenalectomy as well and is spironolactone

still an option? In looking through the files I was unable to locate the

appropriate file or study containing this info.

> I'm returning to my cardiologist on Thursday and was looking for information

to share regarding the best medications for my condition keeping in mind that I

also have other heart issues. (CABG & LBBB) My systolic BP has been creeping up

steadily over the last three weeks and my dystolic has been creeping down. I

have also begun to retain fluid which may account for the BP changes. Lab test

2.5 weeks ago showed normal K (mid-range), low NA and low magnesium.

>

> Brief Summary

>

> Average BP & HR 3 weeks ago

> 118/78 HR 75

>

> Average BP & HR last 7 days

> 130/64 HR 82

>

> Lab results (don't have numbers)

>

> K - normal in Mid-range

>

> Na - Below normal range

>

> Magnesium - Below normal range

>

> Aldosterone - within Normal range

>

> Retaining fluid past 7 days - Swollen feet and legs up 6 lbs

>

> MEDICATIONS

> 2.5 Bystolic

> .25 Digoxin

> 40 mg Lasix

>

[Guest guest]

But I argue that you are a classic case of missed PA for a long time.No! Since 1967, when Conn's group eliminated the need for patient to have low K to Dx primary aldo, no patient with HTN (esp if difficult to control) and low K should be missed by not investigating this classic combination of findings. So as soon as HTN and low K appeared you should have been tested. I assume this started after 1967?The rapid response to spiro if a diagnostic test that you are making too much aldo and eating too much salt.Most PAs do NOT have adrenal abn on CT or MRI until the lesion(s) get big enough to detect with today's technology.I cannot find out what a MGBA scan is???? MIBG maybe? That is to test for pheo not PA.CE Grim MDbut I do not have the classic labs to back it up. Again the classic labs are HTN and low K! I also have a new endo now that I have not met yet since the old one is no longer taking our insurance. But after the years of serious uncontrolled HTN on as many as 5 meds at once, multiple hospitalizations, and very well documented cases of hypokalemia for years, the spiro finally did the trick and did it dramatically. So as for me being an example in a journal I feel like I do not have labs backing up my diagnosis because while they eventually did them, it was only AFTER we started the spiro, and they kept me on the spiro (and I may have still been on an ACEI too) I believe, and nothing was done right. I had at that time the hyperthyroid complicating things also - (though I had NO changes in any thyroid parameter all through 2011 - but tsh is creeping low now 0.60 and some s/s seem to firing up.) My CT said nothing but a 1cm cyst on Kidney and adrenals clear - if I trust it. MGBA scan was clear also. SO I am not a textbook case. What we do know about my case is: 1. Spiro worked at once over 10-20 meds I had tried or been on over 5-6 years - even over 5 meds I was on at the time I started it. 2. Potassium, I still take, worked wonders physically and emotionally on a personal level and seemed to be the root of all my evils at times (I take mag and vit C and iron also for the unk reason anemia)CE Grim MD On Apr 21, 2012, at 12:32 PM, Bingham wrote: Remember though, and I say this alot, is that we came to conclude (the cardiologist initially, and then the endocrinologist) that I had Conn's based primarily on my history and my reaction immediately to the spiro, but I do not have the classic labs to back it up. Again the classic labs are HTN and low K! I also have a new endo now that I have not met yet since the old one is no longer taking our insurance. But after the years of serious uncontrolled HTN on as many as 5 meds at once, multiple hospitalizations, and very well documented cases of hypokalemia for years, the spiro finally did the trick and did it dramatically. So as for me being an example in a journal I feel like I do not have labs backing up my diagnosis because while they eventually did them, it was only AFTER we started the spiro, and they kept me on the spiro (and I may have still been on an ACEI too) I believe, and nothing was done right. I had at that time the hyperthyroid complicating things also - (though I had NO changes in any thyroid parameter all through 2011 - but tsh is creeping low now 0.60 and some s/s seem to firing up.) My CT said nothing but a 1cm cyst on Kidney and adrenals clear - if I trust it. MGBA scan was clear also. SO I am not a textbook case. What we do know about my case is: 1. Spiro worked at once over 10-20 meds I had tried or been on over 5-6 years - even over 5 meds I was on at the time I started it. 2. Potassium, I still take, worked wonders physically and emotionally on a personal level and seemed to be the root of all my evils at times (I take mag and vit C and iron also for the unk reason anemia) 3. I do DASH well - BUT nothing fanatical, and the weak link is I am not getting the K from diet like I could. I exercise as much as I can and make even the smallest effort every night to do SOMETHING. I have a graduate certificate in sports psychology that I did just for self-interest, but I also notice and believe in all of us, exercise is so helpful, but not the amount - sometimes its just the tiniest focused effort and our bodies seem to pick up the slack and if we can just do "something" it will help us ten-fold. I can do, broken up in sections, 50 push ups, 5minutes of jumping jacks and a little weight lifting and I feel incredible. 4. In 2008 I had significant LVH according to Dr Brogan of the Lubbock Heart Institute and spent time in the hospital in Lubbock as his guest. All heart studies done and all was well except LVH and I still was sent home severely HTN and low K. 5. Last echo, late 2010 the doc said no LVH and everything was perfect - though this cardiologist had a mental breakdown my very next visit (long story) and I believe he's since had some "special" care for mental health according to his receptionsist So I am not a picture perfect case. There has to be someone where good labs were done, adenomas found, and so on. I have none of that to date. -- On Sat, 4/21/12, Clarence Grim <lowerbp2@...> wrote: From: Clarence Grim <lowerbp2@...>Subject: Re: Post Adrenalectomy Medicationshyperaldosteronism Cc: "Clarence Grim" <lowerbp2@...>Date: Saturday, April 21, 2012, 11:39 AM I think you have the best documented de-evolution of PA we have here with meds and finally DASHing. I recommend we put this together for a care report for some medical journals esp those that go to PAs and NPs. But know you are busy. you can respond to me at my email. lowerbp2@... CE Grim MD On Apr 18, 2012, at 12:54 AM, Bingham wrote: Kind of an odd question. If it's Post-adrenalectomy why would you need either one (I know there's some catch-up time after surgery)? The whole idea behind yanking your adrenal gland is to stop the hyperaldosteronism (or whatever the issue was). If you have the same high blood pressure after then it wasn't pa and you just lost an adrenal gland...or it still is and they got the wrong one. Hopefully pulling the adrenal solves the problem and you feel better, and you can exercise better and get healthier. And I am sure you are/were already eating as best you can to try and solve the issue on your own before surgery. And Dr G is mainly referring to those medication classes in regards to PA because they are mostly ineffective in that case. Many of us (most maybe?) also have shown evidence of LVH (enlarged left side heart) because of our hypertension being untreated/misdaignosed/ignored for so long .....pick the reason.....but that is recoverable once we control the HTN - usually. Post MI, the BB and ACEI (like lisinopril) show good benefit in remodeling the heart after a heart attack, but spiro has shown, with very good studies, to reduce LVH in those with PA (and some without) when they use it. But here's my take on it.........I so far am a good example as I haven't taken my spiro - except for a couple days last week when I was sick and my BP spiked - for over a month because it was doing great on DASHing and exercise. I am by no means a fanatic for either one and not perfect in either one as I am way too aloof to ever be obsessed over anything, but I am putting in effort and it's really paid off (I am only 44 years old with 7 kiddos and a crazy, but beautiful, red-headed wife ). My story in a nutshell is for many years (2002/2003 was maybe the first inkling of something wrong) and hospital stays, maybe a hundred office/er all total visits over those years and always misdiagnosed/ignored/missed the PA. BP back then was easily 160/120 plus daily for years even on 5 meds sometimes. After two doses of spiro on a cardiologists hunch (I was 184/140 in his office and HE took it over and over and I was on 5 meds that day) I had the very first normal BP in over 5 years (that was in 11/2010). The misdiagnoses and especially the chronic low K caused ALOT of problems that built up over the years, and has nearly ruined me professionally, did ruin us financially (long long story), but I am healthy. I never dashed until I found this site and did as Dr G and everyone suggested (I should have known better but I didn't) and went from 50mg to 25mg to 12.5 mg to nothing. I do still take my K as that part of my diet is the weakest, but I do feel a difference between natural K and the pills. Now I had tests done, but never was one ever done right (they never took me off any meds), and I never had any AVS. My CT did not show anything on my adrenals (can't say I fully trust it, but it is what it is for now - if I come up with the cash I will have Dr G review all my stuff). Endocrine did not want to take me off of the spiro after it worked so well, and said he wouldn't consider me a surgery candidate anyway with the unstable pressure off of it (and I had thyroid trouble too), and so I just worked my butt off. I have some other health issues, but dealing with those as we go. Oh yeah...I tend to ramble a bit, so I aologize, but I meant to say also that at my last echo a year ago at least, the LVH I had was gone. So hopefully you have taken control and DASH and exercise and get off those meds if you can .....and fix that ticker too. You can do it! I've seen Dr. Grim post several times that BB's and CCB's are not the best BP meds for PA. Does this apply to post adrenalectomy as well and is spironolactone still an option? In looking through the files I was unable to locate the appropriate file or study containing this info.I'm returning to my cardiologist on Thursday and was looking for information to share regarding the best medications for my condition keeping in mind that I also have other heart issues. (CABG & LBBB) My systolic BP has been creeping up steadily over the last three weeks and my dystolic has been creeping down. I have also begun to retain fluid which may account for the BP changes. Lab test 2.5 weeks ago showed normal K (mid-range), low NA and low magnesium.Brief Summary Average BP & HR 3 weeks ago118/78 HR 75Average BP & HR last 7 days 130/64 HR 82Lab results (don't have numbers)K - normal in Mid-rangeNa - Below normal rangeMagnesium - Below normal rangeAldosterone - within Normal rangeRetaining fluid past 7 days - Swollen feet and legs up 6 lbsMEDICATIONS2.5 Bystolic.25 Digoxin40 mg Lasix

[Guest guest]

But I argue that you are a classic case of missed PA for a long time.No! Since 1967, when Conn's group eliminated the need for patient to have low K to Dx primary aldo, no patient with HTN (esp if difficult to control) and low K should be missed by not investigating this classic combination of findings. So as soon as HTN and low K appeared you should have been tested. I assume this started after 1967?The rapid response to spiro if a diagnostic test that you are making too much aldo and eating too much salt.Most PAs do NOT have adrenal abn on CT or MRI until the lesion(s) get big enough to detect with today's technology.I cannot find out what a MGBA scan is???? MIBG maybe? That is to test for pheo not PA.CE Grim MDbut I do not have the classic labs to back it up. Again the classic labs are HTN and low K! I also have a new endo now that I have not met yet since the old one is no longer taking our insurance. But after the years of serious uncontrolled HTN on as many as 5 meds at once, multiple hospitalizations, and very well documented cases of hypokalemia for years, the spiro finally did the trick and did it dramatically. So as for me being an example in a journal I feel like I do not have labs backing up my diagnosis because while they eventually did them, it was only AFTER we started the spiro, and they kept me on the spiro (and I may have still been on an ACEI too) I believe, and nothing was done right. I had at that time the hyperthyroid complicating things also - (though I had NO changes in any thyroid parameter all through 2011 - but tsh is creeping low now 0.60 and some s/s seem to firing up.) My CT said nothing but a 1cm cyst on Kidney and adrenals clear - if I trust it. MGBA scan was clear also. SO I am not a textbook case. What we do know about my case is: 1. Spiro worked at once over 10-20 meds I had tried or been on over 5-6 years - even over 5 meds I was on at the time I started it. 2. Potassium, I still take, worked wonders physically and emotionally on a personal level and seemed to be the root of all my evils at times (I take mag and vit C and iron also for the unk reason anemia)CE Grim MD On Apr 21, 2012, at 12:32 PM, Bingham wrote: Remember though, and I say this alot, is that we came to conclude (the cardiologist initially, and then the endocrinologist) that I had Conn's based primarily on my history and my reaction immediately to the spiro, but I do not have the classic labs to back it up. Again the classic labs are HTN and low K! I also have a new endo now that I have not met yet since the old one is no longer taking our insurance. But after the years of serious uncontrolled HTN on as many as 5 meds at once, multiple hospitalizations, and very well documented cases of hypokalemia for years, the spiro finally did the trick and did it dramatically. So as for me being an example in a journal I feel like I do not have labs backing up my diagnosis because while they eventually did them, it was only AFTER we started the spiro, and they kept me on the spiro (and I may have still been on an ACEI too) I believe, and nothing was done right. I had at that time the hyperthyroid complicating things also - (though I had NO changes in any thyroid parameter all through 2011 - but tsh is creeping low now 0.60 and some s/s seem to firing up.) My CT said nothing but a 1cm cyst on Kidney and adrenals clear - if I trust it. MGBA scan was clear also. SO I am not a textbook case. What we do know about my case is: 1. Spiro worked at once over 10-20 meds I had tried or been on over 5-6 years - even over 5 meds I was on at the time I started it. 2. Potassium, I still take, worked wonders physically and emotionally on a personal level and seemed to be the root of all my evils at times (I take mag and vit C and iron also for the unk reason anemia) 3. I do DASH well - BUT nothing fanatical, and the weak link is I am not getting the K from diet like I could. I exercise as much as I can and make even the smallest effort every night to do SOMETHING. I have a graduate certificate in sports psychology that I did just for self-interest, but I also notice and believe in all of us, exercise is so helpful, but not the amount - sometimes its just the tiniest focused effort and our bodies seem to pick up the slack and if we can just do "something" it will help us ten-fold. I can do, broken up in sections, 50 push ups, 5minutes of jumping jacks and a little weight lifting and I feel incredible. 4. In 2008 I had significant LVH according to Dr Brogan of the Lubbock Heart Institute and spent time in the hospital in Lubbock as his guest. All heart studies done and all was well except LVH and I still was sent home severely HTN and low K. 5. Last echo, late 2010 the doc said no LVH and everything was perfect - though this cardiologist had a mental breakdown my very next visit (long story) and I believe he's since had some "special" care for mental health according to his receptionsist So I am not a picture perfect case. There has to be someone where good labs were done, adenomas found, and so on. I have none of that to date. -- On Sat, 4/21/12, Clarence Grim <lowerbp2@...> wrote: From: Clarence Grim <lowerbp2@...>Subject: Re: Post Adrenalectomy Medicationshyperaldosteronism Cc: "Clarence Grim" <lowerbp2@...>Date: Saturday, April 21, 2012, 11:39 AM I think you have the best documented de-evolution of PA we have here with meds and finally DASHing. I recommend we put this together for a care report for some medical journals esp those that go to PAs and NPs. But know you are busy. you can respond to me at my email. lowerbp2@... CE Grim MD On Apr 18, 2012, at 12:54 AM, Bingham wrote: Kind of an odd question. If it's Post-adrenalectomy why would you need either one (I know there's some catch-up time after surgery)? The whole idea behind yanking your adrenal gland is to stop the hyperaldosteronism (or whatever the issue was). If you have the same high blood pressure after then it wasn't pa and you just lost an adrenal gland...or it still is and they got the wrong one. Hopefully pulling the adrenal solves the problem and you feel better, and you can exercise better and get healthier. And I am sure you are/were already eating as best you can to try and solve the issue on your own before surgery. And Dr G is mainly referring to those medication classes in regards to PA because they are mostly ineffective in that case. Many of us (most maybe?) also have shown evidence of LVH (enlarged left side heart) because of our hypertension being untreated/misdaignosed/ignored for so long .....pick the reason.....but that is recoverable once we control the HTN - usually. Post MI, the BB and ACEI (like lisinopril) show good benefit in remodeling the heart after a heart attack, but spiro has shown, with very good studies, to reduce LVH in those with PA (and some without) when they use it. But here's my take on it.........I so far am a good example as I haven't taken my spiro - except for a couple days last week when I was sick and my BP spiked - for over a month because it was doing great on DASHing and exercise. I am by no means a fanatic for either one and not perfect in either one as I am way too aloof to ever be obsessed over anything, but I am putting in effort and it's really paid off (I am only 44 years old with 7 kiddos and a crazy, but beautiful, red-headed wife ). My story in a nutshell is for many years (2002/2003 was maybe the first inkling of something wrong) and hospital stays, maybe a hundred office/er all total visits over those years and always misdiagnosed/ignored/missed the PA. BP back then was easily 160/120 plus daily for years even on 5 meds sometimes. After two doses of spiro on a cardiologists hunch (I was 184/140 in his office and HE took it over and over and I was on 5 meds that day) I had the very first normal BP in over 5 years (that was in 11/2010). The misdiagnoses and especially the chronic low K caused ALOT of problems that built up over the years, and has nearly ruined me professionally, did ruin us financially (long long story), but I am healthy. I never dashed until I found this site and did as Dr G and everyone suggested (I should have known better but I didn't) and went from 50mg to 25mg to 12.5 mg to nothing. I do still take my K as that part of my diet is the weakest, but I do feel a difference between natural K and the pills. Now I had tests done, but never was one ever done right (they never took me off any meds), and I never had any AVS. My CT did not show anything on my adrenals (can't say I fully trust it, but it is what it is for now - if I come up with the cash I will have Dr G review all my stuff). Endocrine did not want to take me off of the spiro after it worked so well, and said he wouldn't consider me a surgery candidate anyway with the unstable pressure off of it (and I had thyroid trouble too), and so I just worked my butt off. I have some other health issues, but dealing with those as we go. Oh yeah...I tend to ramble a bit, so I aologize, but I meant to say also that at my last echo a year ago at least, the LVH I had was gone. So hopefully you have taken control and DASH and exercise and get off those meds if you can .....and fix that ticker too. You can do it! I've seen Dr. Grim post several times that BB's and CCB's are not the best BP meds for PA. Does this apply to post adrenalectomy as well and is spironolactone still an option? In looking through the files I was unable to locate the appropriate file or study containing this info.I'm returning to my cardiologist on Thursday and was looking for information to share regarding the best medications for my condition keeping in mind that I also have other heart issues. (CABG & LBBB) My systolic BP has been creeping up steadily over the last three weeks and my dystolic has been creeping down. I have also begun to retain fluid which may account for the BP changes. Lab test 2.5 weeks ago showed normal K (mid-range), low NA and low magnesium.Brief Summary Average BP & HR 3 weeks ago118/78 HR 75Average BP & HR last 7 days 130/64 HR 82Lab results (don't have numbers)K - normal in Mid-rangeNa - Below normal rangeMagnesium - Below normal rangeAldosterone - within Normal rangeRetaining fluid past 7 days - Swollen feet and legs up 6 lbsMEDICATIONS2.5 Bystolic.25 Digoxin40 mg Lasix

[Guest guest]

That's funny you write it like that as I was born in 1967 "the Summer of Love"....and Jimi Hendrix!

I agree there that I had ALL the signs. I mean I was young, I was healthy, VERY athletic, NO risk factors like smoking, drinking, etc, and then about 2002-2003 started noticing HTN at checkups and then by the end of 2003 the signs of low K were no doubt happening (I have journals from then that state what I mean) and it got higher and higher and K was replaced maybe 20 times between 2004 and 2010! And PA was never ever checked even in the hospital stays.

So we can sure do a "missing the missing link" article and I have been DASHing (and not even fanatically as I have said yet it is making such a difference).

From: Clarence Grim <lowerbp2@...>Subject: Re: Post Adrenalectomy Medicationshyperaldosteronism Cc: "Clarence Grim" <lowerbp2@...>Date: Sunday, April 22, 2012, 12:18 AM

But I argue that you are a classic case of missed PA for a long time.

No! Since 1967, when Conn's group eliminated the need for patient to have low K to Dx primary aldo, no patient with HTN (esp if difficult to control) and low K should be missed by not investigating this classic combination of findings.

So as soon as HTN and low K appeared you should have been tested. I assume this started after 1967?

The rapid response to spiro if a diagnostic test that you are making too much aldo and eating too much salt.

Most PAs do NOT have adrenal abn on CT or MRI until the lesion(s) get big enough to detect with today's technology.

I cannot find out what a MGBA scan is????

MIBG maybe? That is to test for pheo not PA.

CE Grim MD

but I do not have the classic labs to back it up.

Again the classic labs are HTN and low K!

I also have a new endo now that I have not met yet since the ol

d one is no longer taking our insurance. But after the years of serious uncontrolled HTN on as many as 5 meds at once, multiple hospitalizations, and very well documented cases of hypokalemia for years, the spiro finally did the trick and did it dramatically. So as for me being an example in a journal I feel like I do not have labs backing up my diagnosis because while they eventually did them, it was only AFTER we started the spiro, and they kept me on the spiro (and I may have still been on an ACEI too) I believe, and nothing was done right. I had at that time the hyperthyroid complicating things also - (though I had NO changes in any thyroid parameter all through 2011 - but tsh is creeping low now 0.60 and some s/s seem to firing up.)

My CT said nothing but a 1cm cyst on Kidney and adrenals clear - if I trust it.

MGBA scan was clear also.

SO I am not a textbook case. What we do know about my case is:

1. Spiro worked at once over 10-20 meds I had tried or been on over 5-6 years - even over 5 meds I was on at the time I started it.

2. Potassium, I still take, worked wonders physically and emotionally on a personal level and seemed to be the root of all my evils at times (I take mag and vit C and iron also for the unk reason anemia)

CE Grim MD

On Apr 21, 2012, at 12:32 PM, Bingham wrote:

Remember though, and I say this alot, is that we came to conclude (the cardiologist initially, and then the endocrinologist) that I had Conn's based primarily on my history and my reaction immediately to the spiro, but I do not have the classic labs to back it up.

Again the classic labs are HTN and low K!

I also have a new endo now that I have not met yet since the old one is no longer taking our insurance. But after the years of serious uncontrolled HTN on as many as 5 meds at once, multiple hospitalizations, and very well documented cases of hypokalemia for years, the spiro finally did the trick and did it dramatically. So as for me being an example in a journal I feel like I do not have labs backing up my diagnosis because while they eventually did them, it was only AFTER we started the spiro, and they kept me on the spiro (and I may have still been on an ACEI too) I believe, and nothing was done right. I had at that time the hyperthyroid complicating things also - (though I had NO changes in any thyroid parameter all through 2011 - but tsh is creeping low now 0.60 and some s/s seem to firing up.)

My CT said nothing but a 1cm cyst on Kidney and adrenals clear - if I trust it.

MGBA scan was clear also.

SO I am not a textbook case. What we do know about my case is:

1. Spiro worked at once over 10-20 meds I had tried or been on over 5-6 years - even over 5 meds I was on at the time I started it.

2. Potassium, I still take, worked wonders physically and emotionally on a personal level and seemed to be the root of all my evils at times (I take mag and vit C and iron also for the unk reason anemia)

3. I do DASH well - BUT nothing fanatical, and the weak link is I am not getting the K from diet like I could. I exercise as much as I can and make even the smallest effort every night to do SOMETHING. I have a graduate certificate in sports psychology that I did just for self-interest, but I also notice and believe in all of us, exercise is so helpful, but not the amount - sometimes its just the tiniest focused effort and our bodies seem to pick up the slack and if we can just do "something" it will help us ten-fold. I can do, broken up in sections, 50 push ups, 5minutes of jumping jacks and a little weight lifting and I feel incredible.

4. In 2008 I had significant LVH according to Dr Brogan of the Lubbock Heart Institute and spent time in the hospital in Lubbock as his guest. All heart studies done and all was well except LVH and I still was sent home severely HTN and low K.

5. Last echo, late 2010 the doc said no LVH and everything was perfect - though this cardiologist had a mental breakdown my very next visit (long story) and I believe he's since had some "special" care for mental health according to his receptionsist

So I am not a picture perfect case. There has to be someone where good labs were done, adenomas found, and so on. I have none of that to date.

-- On Sat, 4/21/12, Clarence Grim <lowerbp2@...> wrote:

From: Clarence Grim <lowerbp2@...>Subject: Re: Post Adrenalectomy Medicationshyperaldosteronism Cc: "Clarence Grim" <lowerbp2@...>Date: Saturday, April 21, 2012, 11:39 AM

I think you have the best documented de-evolution of PA we have here with meds and finally DASHing. I recommend we put this together for a care report for some medical journals esp those that go to PAs and NPs.

But know you are busy.

you can respond to me at my email. lowerbp2@...

CE Grim MD

On Apr 18, 2012, at 12:54 AM, Bingham wrote:

Kind of an odd question. If it's Post-adrenalectomy why would you need either one (I know there's some catch-up time after surgery)? The whole idea behind yanking your adrenal gland is to stop the hyperaldosteronism (or whatever the issue was). If you have the same high blood pressure after then it wasn't pa and you just lost an adrenal gland...or it still is and they got the wrong one. Hopefully pulling the adrenal solves the problem and you feel better, and you can exercise better and get healthier. And I am sure you are/were already eating as best you can to try and solve the issue on your own before surgery.

And Dr G is mainly referring to those medication classes in regards to PA because they are mostly ineffective in that case. Many of us (most maybe?) also have shown evidence of LVH (enlarged left side heart) because of our hypertension being untreated/misdaignosed/ignored for so long .....pick the reason.....but that is recoverable once we control the HTN - usually. Post MI, the BB and ACEI (like lisinopril) show good benefit in remodeling the heart after a heart attack, but spiro has shown, with very good studies, to reduce LVH in those with PA (and some without) when they use it.

But here's my take on it.........I so far am a good example as I haven't taken my spiro - except for a couple days last week when I was sick and my BP spiked - for over a month because it was doing great on DASHing and exercise. I am by no means a fanatic for either one and not perfect in either one as I am way too aloof to ever be obsessed over anything, but I am putting in effort and it's really paid off (I am only 44 years old with 7 kiddos and a crazy, but beautiful, red-headed wife ). My story in a nutshell is for many years (2002/2003 was maybe the first inkling of something wrong) and hospital stays, maybe a hundred office/er all total visits over those years and always misdiagnosed/ignored/missed the PA. BP back then was easily 160/120 plus daily for years even on 5 meds sometimes.

After two doses of spiro on a cardiologists hunch (I was 184/140 in his office and HE took it over and over and I was on 5 meds that day) I had the very first normal BP in over 5 years (that was in 11/2010). The misdiagnoses and especially the chronic low K caused ALOT of problems that built up over the years, and has nearly ruined me professionally, did ruin us financially (long long story), but I am healthy. I never dashed until I found this site and did as Dr G and everyone suggested (I should have known better but I didn't) and went from 50mg to 25mg to 12.5 mg to nothing. I do still take my K as that part of my diet is the weakest, but I do feel a difference between natural K and the pills.

Now I had tests done, but never was one ever done right (they never took me off any meds), and I never had any AVS. My CT did not show anything on my adrenals (can't say I fully trust it, but it is what it is for now - if I come up with the cash I will have Dr G review all my stuff). Endocrine did not want to take me off of the spiro after it worked so well, and said he wouldn't consider me a surgery candidate anyway with the unstable pressure off of it (and I had thyroid trouble too), and so I just worked my butt off. I have some other health issues, but dealing with those as we go.

Oh yeah...I tend to ramble a bit, so I aologize, but I meant to say also that at my last echo a year ago at least, the LVH I had was gone. So hopefully you have taken control and DASH and exercise and get off those meds if you can .....and fix that ticker too. You can do it!

I've seen Dr. Grim post several times that BB's and CCB's are not the best BP meds for PA. Does this apply to post adrenalectomy as well and is spironolactone still an option? In looking through the files I was unable to locate the appropriate file or study containing this info.I'm returning to my cardiologist on Thursday and was looking for information to share regarding the best medications for my condition keeping in mind that I also have other heart issues. (CABG & LBBB) My systolic BP has been creeping up steadily over the last three weeks and my dystolic has been creeping down. I have also begun to retain fluid which may account for the BP changes. Lab test 2.5 weeks ago showed normal K (mid-range), low NA and low magnesium.Brief Summary Average BP & HR 3 weeks ago118/78 HR 75Average BP & HR last 7 days 130/64 HR 82Lab results (don't have numbers)K - normal in Mid-rangeNa

- Below normal rangeMagnesium - Below normal rangeAldosterone - within Normal rangeRetaining fluid past 7 days - Swollen feet and legs up 6 lbsMEDICATIONS2.5 Bystolic.25 Digoxin40 mg Lasix