Re: Re: Post adrenolectomy meds

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The question is why is your BP still a problem?Possibilities are:1. You had essential HTN BEFORE PA and that is the problem now. What is ur FHx of HTN as far back as you can go looking at age and causes of death using the NIH medical family tree site in our intro. Discuss this with your team. 2. You have had PA for many years and have still not recovered from the damage done to blood vessels which is still getting better. DASHing will make the healing faster as well as lower BP in # 1.Most drugs should work in 1 and 2 if you do not out salt them.3. You still have excess also production from other adrenal or an ectopic adrenal adenoma. In this case your renin would still be low and aldo not low. What was date from surgery of last renin also and urine lytes done?Drugs that don't work in PA will not work here. Spironolactone should get you to goal if u do not out salt it. 4. If renin and aldo are both low then you are eating too much salt or licorice. 5. You have another cause of HTN of which there are at least 100. Your team should be able to figure this out if 1-4 are not the problem. Keep us posted. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Apr 23, 2012, at 12:14, lyndarumph <lyndarumph@...> wrote:

I guess u didn't see my previous blog. I was on all those meds before adrenolectomy and my BP is better but it fluctuates to 150/90s sometimes 150/100 even with metoprolol 100 mg. My question was directed to Dr. Grimm because he said BBCs and CCBs don't always work so I was asking what does. Because a doc is not going to be happy about getting a BP up and down. Other gland was fine and I don't have other med problems.

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> From: lyndarumph <lyndarumph@...>

> Subject: Post adrenolectomy meds

> hyperaldosteronism

> Date: Thursday, April 19, 2012, 10:55 AM

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> If BBCs and CCBs don't work for BP after adrenolectomy what does. Metoprolol didn't work anyway. But because BP is better 120s/80s diastolic runs a little high but it use to be 180s/110. Was taking 360 cardizem 320 divan 40 lisinopril 325 aspirin,minoxidil and HCL 12.5. All once a day plus 50 of toprol. No of them got pressure down.. How can they tell if toprol is working or adrenal gland doing it?

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So they took a biopsy of the R gland? Otherwise they will not know and suspect they did not do it. Some have done it in the old days. And found hyperplasia on the other side. But can't find reference now. Indeed for awhile we were doing a kidney BX at the time of adrenal surgery to see if it predicted poor response. Not useful in our small group but others may have done more say MAYO or Cleveland clinic. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Apr 23, 2012, at 12:27, lyndarumph <lyndarumph@...> wrote:

Had adrenolectomy and had follow up and aldosterone was ok. Not out salting if that means eating too much salt. Just didnt know why BP fluctuating so much and taking 100 mg of metoprolol now. Just getting frustrated that's all. Just docs couldn't figure it out before and just want to be sure the same thing isn't going on again.Univ of Penn said right gland was ok.

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> > If BBCs and CCBs don't work for BP after adrenolectomy what does. Metoprolol didn't work anyway. But because BP is better 120s/80s diastolic runs a little high but it use to be 180s/110. Was taking 360 cardizem 320 divan 40 lisinopril 325 aspirin,minoxidil and HCL 12.5. All once a day plus 50 of toprol. No of them got pressure down.. How can they tell if toprol is working or adrenal gland doing it?

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There is a beautiful older book called Perspiration by Kuno. I have some discussion of sweating and survival in my papers on survival during slavery.

I can't recall if my slavery papers are in our files?I am a bit of a sweat expert as well. Studied it in Dr. Conn's lab to see if sweat Na/K could be used to Dx PA. Good for advanced cases but have to go in sweat box. Aldo also affects stool Na and K and pH that has been used for Dx but not very clean in separating. On Apr 23, 2012, at 12:37 PM, lyndarumph wrote: Saw the website on BP s and sweat. Very good. I do most of those anyway. I actually had lost 37lbs last year and was at the gym everyday exercising and eating only fish and vegetables and that was before the adrenolectomy and BP was in the 180s/110. BP was really good after adrenolectomy 4 weeks ago. Don't know what's going on > > > > > > From: lyndarumph <lyndarumph@> > > Subject: Post adrenolectomy meds > > hyperaldosteronism > > Date: Thursday, April 19, 2012, 10:55 AM > > > > > > > > Â > > > > > > > > If BBCs and CCBs don't work for BP after adrenolectomy what does. Metoprolol didn't work anyway. But because BP is better 120s/80s diastolic runs a little high but it use to be 180s/110. Was taking 360 cardizem 320 divan 40 lisinopril 325 aspirin,minoxidil and HCL 12.5. All once a day plus 50 of toprol. No of them got pressure down.. How can they tell if toprol is working or adrenal gland doing it? > > >

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Sounds like met and or DASHING are working. Keep up the good work. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Apr 27, 2012, at 18:10, lyndarumph <lyndarumph@...> wrote:

Don't know if they did biopsy of R gland only the AVS. FHx the elderly that died was from altzheimers and old age some r still living. Mother had HTN but died from scleroderma. Don't know father or his family. Now my BP has been as low as 100/80s-130s/90s. Just wondering if metoprolol is working. Took spironolactone before surgery didn't like side effects that's why I chose surgery.

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> > > > If BBCs and CCBs don't work for BP after adrenolectomy what does. Metoprolol didn't work anyway. But because BP is better 120s/80s diastolic runs a little high but it use to be 180s/110. Was taking 360 cardizem 320 divan 40 lisinopril 325 aspirin,minoxidil and HCL 12.5. All once a day plus 50 of toprol. No of them got pressure down.. How can they tell if toprol is working or adrenal gland doing it?

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AZD also tends to have a low steady decline. Vascular dementia tend to worsen in sputs likely due to little strokes from HTN/high lipids etc.Many have both I suspect. CE Grim MDOn Apr 29, 2012, at 10:54 AM, wrote: Alzheimer is one thing you don't need to explain to me. Having been a caregiver of 8+ years and watching my father deteriorate, trust me, I KNOW THE DIFFERENCE! Only idiots use them interchangebly, IMHO! > > > > > > > > > > > > > > > > > > > > > If BBCs and CCBs don't work for BP after adrenolectomy > > what does. Metoprolol didn't work anyway. But because BP is better > > 120s/80s diastolic runs a little high but it use to be 180s/110. Was > > taking 360 cardizem 320 divan 40 lisinopril 325 aspirin,minoxidil and > > HCL 12.5. All once a day plus 50 of toprol. No of them got pressure > > down.. How can they tell if toprol is working or adrenal gland doing it? > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >

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: and others if you have not done sol I still recommend going to the NIH family medical tree and fill it out as far back as you can with ages and causes of death and illnesses. It will be useful to you health care team and to your family.For example if GRA is found the every other person in the family (first degree relatives) are likely to have it. Same for familial hypercholesterolemia.See item in our welcome for where to go. Welcome to the exciting world of Hyperaldosteronism You are in the right place! I am Dr. CE Grim a retired (well semi-retired) Professor of Medicine and Endocrinology. I have had a long standing interest is Primary Aldosteronism since medical school days when I saw my first patient with Primary Aldosteronism in 1963 as a 4th year medical student. I did a Nephrology Fellowship at Duke and an Endocrinology and Metabolism Fellowship with Dr. Conn (1969-70). I have been on the faculty of the University of MO, Indiana Univ, UCLA/ R. Drew, and the Medical College of Wisconsin in Divisions of Nephrology, Endocrinology, Hypertension, Cardiology and Epidemiology. I have published over 240 papers and book chapters in most areas of the broad discipline of High Blood Pressure. My CV is in our files for details. The GOAL of our group is to teach you and your health care team about the ins and outs of the causes, diagnosis and control of the many forms of hyperaldosteronism. The steps below will introduce you into the fascinating world of high blood pressure, salt and potassium and the role of the adrenal hormone aldosterone in health and disease. Doing these in sequence will save you time and effort in getting up to speed in taking control of you health and educating your own health care team. While we can’t make you a doctor we will make you into a pretty good BP doctor-a skill that you will have for life. 1. Overview: Read my article in our files on the evolution of PA (Evolution_of_PA-Grim.pdf ) and take to all members of health care team. Tell us what stage you believe you are in. This is a brief review of most causes of hyperaldosteronism, high blood pressure, and low potassium (K). Be certain that you and your health care team understand the key role of excess diet salt in HTN and especially in PA. Without excess salt in the diet, aldosterone cannot do most of its damage. Go to: http://www.worldactiononsalt.com/evidence/treatment_trials.htm For a state of the art and science discussion of salt and health. 2. Conn's Stories. Other patients with hyperaldosteronism (Conn’s syndrome). Read our Conn's stories in our files and then give us your own in as much detail as you can. Dr. Conn was the first to describe this disease process and the syndrome is named after him. I trained with he and his team in Ann Arbor, MI in 1969. To see others' stories, on the Hyperaldosteronism home page, go to Files/Conn’s Stories. You'll find instructions in "A - How to put your story here.doc "Then send us your story in an email and then we will likely ask more questions and make suggestions before you upload it to our files. 3. Hyperaldosteronism and Salt: The Deadly Duo. Eating Plan to control high blood pressure due to hyperaldosteronism and most others with high blood pressure. This will reduce your need for medications and in many will get your BP and K to goal without meds.. Get the DASH diet book by T. et al, read it and use it: $8 in paperback at your local bookstore. If they don’t have it ask them to order it for you. Learning to eat the DASH way will play a major role in your road to good BP and K control and, in many of our folks here, will revolutionize your life. Go to chapter 9 and do the 14 day challenge. Tell your Dr you are doing this as your BP may plummet if you are on other meds in only 2-3 days. or go to http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf download this 64 page booklet free and do the Week on the DASH Diet for 2 weeks. If you are on BP meds be prepared for a large fall in BP and let your Dr. know you are doing this. Or go to (but costs money) DASH Diet for Health ProgramThe DASH Diet for Health Program is designed to help you improve your eating and exercise habits. Twice each week we will provide you with information on our website about food, food preparation, eating out, losing weight, getting fit and much more. In addition to providing new information each week on our website, we create a web page specially for you where you can track progress in areas such as your weight, blood pressure, and exercise.http://www.dashforhealth.com/ I strongly recommend you get the book and read it now! 4. Measure your own BP and insist that your health care team always measures BP correctly with an recently calibrated device: Measure your BP daily so you can see if it is getting better. If you are taking meds be sure to tell your health care team you are doing this as your BP may plummet to normal quickly. We recommend you use a device you listen to and will help you learn how to do this. If this is not something you want to do we can teach a significant other how to do it. See sharedcareinc.com or email to sharedcare@... to order a video on how to do this. If you already have one we will teach you how to teach your health care team how to validate your device. Your life and health depends on accurate BP measurements. Go to the amricanheart.org and download the Guidelines for Human Blood Pressure Measurement. Insist the your health care team do BP the AHA way. Your life is in the hands of those who measure your BP. Never trust your life to an automatic BP machine unless you know it is accurate on YOU. 5. Genetics and your BP: Go to familyhistory.hhs.gov and do your detailed family medical history so we can review with you to help Dx familial causes of high blood pressure and heart disease. If BP runs in your family you may save lives in your family by checking their BP yourself. There is a brief discussion of this in my Evolution Article. 6. How to DX and treat PA: Go to our file/Conn's Articles of Note/Medications/Bravo spir 1973.pdf and read this article and take to your health care team. It is old but still one of the best in the medical management of PA. Also see our file from the Endocrine Society Guidelines on PA. Dr. Grim's Perfect Primary Aldosteronism Blood and Urine Testing to diagnose PA in one day. 1. Eat a high salt diet for 2 weeks-at least 4000 mg of Na a day. 2. No BP meds in last 4-12 weeks depending on meds and Drs advice. 3. Collect 24 hr urine for Na, K and creatinine and aldosterone. Do not lose a drop of this liquid gold. It is impossible to interpret the plasma renin and aldosterone and urine aldosterone without this. 4. The morning you finish the 24 hr urine have fasting blood drawn for renin, aldosterone and K using our guidelines to get an accurate K. Try to get this done about 1-4 hours after you have been out of bed. Be sure the laboratory orders and does aldosterone NOT aldolase. 5. Send us the results with the normal values for your lab. 6. If you ever have a salt (saline) infusion test for PA be certain to ask them to measure how much you pee during the 4 hours of the infusion. If it is 1-1.5 liter of urine it strongly suggests that you may have PA. If more tha 1.5 L you almost certainly have PA. I call this Dr. Grim’s “Quick Pee Test” for PA. 7. Our PA Registry: If you have been Dxed with PA already and are on Rx or have had surgery please go to http://www.kwiksurveys.com/online-survey.php?surveyID=HIJIO_f2685379 and complete our survey with as much information as you know. If there is some information you don't know ask us and we will help. If you need to update this as you journey thru the diagnostic/treatment process you can add another entry but label it as Nameyymmdd. For example today 4/20/11 for me would be Grim110420. This way of writing the date is an ever increasing number and will allow us and you to sort your multiple entries into a dated order. We are working on a more extensive database. 8. Learn the language: If you are new to medical lingo then download the acroyms from bloodpressureline/message/291869. Salt and high blood pressure: To learn the state of the science of salt and blood pressure please spend some time looking at http://www.worldactiononsalt.com/evidence/treatment_trials.htm10. Become a HBP expert consumer: Expect that it will take at least several weeks to get all this digested and to learn the new language of high blood pressure health care. As most doctors and nurses in practice have had very little training in high blood pressure you must become an expert yourself. For example most have never had anyone listen with them with a double stethoscope to verify that they can hear BP sounds. We cannot make you a doctor but we will make you a pretty good BP doctor.11. Learn as much as you can about how High Blood Pressure should be diagnosed and managed: Go to nih.gov and download and read the latest Joint National Commission (JNC) Report to get an overview on current guidelines. I have always asked all my staff (including secretaries) to read this so they can communicate the importance of high blood pressure to my patients. Then: get (and study) the Hypertension Primer from americanheart.org. This is the most up-to-date compendium of what is known about high blood pressure and what every Dr. should know when they graduate from Medical School. Every chapter is only 2-3 pages. Read one chapter every week-night and you will finish it in about a year. I am working on a reading guide for lay people for the Primer. Stay tuned.12. Ask us questions: Ask any questions about high blood pressure you want answered. That is what we are here for.13. One-on-one Consulting: I can provide individual consulting if you do not want to go public. If you want individual one-on-one consulting for you and your Doctor contract me directly at lowerbp2@....May your pressure be low!Clarence E. Grim BS, MS, MD, FACP, FACC, FASH.Board Certified in Internal Medicine, Geriatrics, and High Blood Pressure Specializing in Primary Aldosteronism and Difficult to Control High Blood Pressure. On Apr 29, 2012, at 5:36 PM, lyndarumph wrote: Lol. Remember u asked me about it. Weird but this week my BP is 100s-115/70s-80s > > > > > > > > > > > > > > > > > > > If BBCs and CCBs don't work for BP after adrenolectomy > what does. Metoprolol didn't work anyway. But because BP is better > 120s/80s diastolic runs a little high but it use to be 180s/110. Was > taking 360 cardizem 320 divan 40 lisinopril 325 aspirin,minoxidil and > HCL 12.5. All once a day plus 50 of toprol. No of them got pressure > down.. How can they tell if toprol is working or adrenal gland doing it? > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >

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If you are close to a memory research center (Say Wash U in St. L) recommend contacting them to see what issues they are studying. Most will want the brain when it is all over as that is the only way to Dx ALZ for sure. They may also do blood and spinal fluid testing. CE Grim MDOn Apr 29, 2012, at 6:38 PM, maggiekat7 wrote: There are many types and etiology of dementia; one if which is alzheimer's. Stroke due to hypertension or atherosclerosis can also result in dementia. Aging, Pick's disease, frontal lobe dementia are all other causes and types. There are also types of Alzheimer's, such as early onset Alzheimer's. > > > > > > > > > > > > > > > > > > > > > > > If BBCs and CCBs don't work for BP after adrenolectomy > > > what does. Metoprolol didn't work anyway. But because BP is better > > > 120s/80s diastolic runs a little high but it use to be 180s/110. Was > > > taking 360 cardizem 320 divan 40 lisinopril 325 aspirin,minoxidil and > > > HCL 12.5. All once a day plus 50 of toprol. No of them got pressure > > > down.. How can they tell if toprol is working or adrenal gland doing it? > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >

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Suspect u are still adjusting to changes in diet etc but with no thumbnail I cannot remember May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn May 6, 2012, at 15:49, lyndarumph <lyndarumph@...> wrote:

Hello everyone.

Have been busy. BP doing very well now. Has been highest at 130/84. Been mostly 110-119/70s-80s. Get a little lightheaded at night and it is usually at 100/68. Have more follow up visits with doc. Might have to wean off metoprolol to 75 mg instead of 100mg daily.

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I had some very lows after I started the spiro, and fainted once and ended up in the ER while I was in the bathroom at a meeting. Dr G back then suggesting it was my receptors and other things adapting to the new low BP - or I should a now normal BP and sure enough I can get a little low if all I do is salads for a few days, but it seems to have adapted like he said. It was at least a year for me to get my BP less labile though, after all those years of it being high.

You may end up like you said, weening of some of the other meds. That's good of course!

From: lyndarumph <lyndarumph@...>Subject: Re: Post adrenolectomy medshyperaldosteronism Date: Sunday, May 6, 2012, 3:49 PM

Hello everyone. Have been busy. BP doing very well now. Has been highest at 130/84. Been mostly 110-119/70s-80s. Get a little lightheaded at night and it is usually at 100/68. Have more follow up visits with doc. Might have to wean off metoprolol to 75 mg instead of 100mg daily. > > > > > > > > > > > >> > > > > > >

> > > > > > If BBCs and CCBs don't work for BP after > > > adrenolectomy> > > > what does. Metoprolol didn't work anyway. But because BP is better> > > > 120s/80s diastolic runs a little high but it use to be 180s/110. Was> > > > taking 360 cardizem 320 divan 40 lisinopril 325 aspirin,minoxidil > > > and> > > > HCL 12.5. All once a day plus 50 of toprol. No of them got pressure> > > > down.. How can they tell if toprol is working or adrenal gland > > > doing it?> > > > > > > > > > > > >> > > > > > > > > > > > >> > > > > > > > > > > >> > > > > > > > > > >> > > > > > > > > > >> > > > > > > > >

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