Re: Testing was done correclty it seems to me.

[Guest guest]

Base on your story you have PA it appears to me. Any good medical student can make the Dx based on your Hx.What info was Endo looking at that engendered the statement no way?Read my Evolution article again. Then take/send it to all the Drs who missed you Dx so they do not miss anymore of the many they will see.Please give us the following information again as it is not clear.My 24 hr urine ENa was ______ mM/24 hr and my EK was ____ mM/24 hrThis was on the same day my blood renin and aldo was done yes or noWas an aldosterone measured in this urine? If so it was____/24 hr.My blood test for renin was ______ and my aldosterone was _______ On Jan 5, 2012, at 7:11 AM, StaceyF wrote: Thank you Dr. Grim for your reply. Yes, my Na was 163 mM/24H and K+ in urine was mM/24hr. I assumed that it was then 163 not 198. My aldosterone is ng/dl. That is why I was wondering if I needed to do another confirmatory test to be sure I got the correct sodium loading. I have looked at the dashing diet and I already do a pretty low salt diet. Normally my salt excretion when tested in the past is 80 mM/24h. I just need to feel better and so far none of the doctors want to agree that it could be an endocrine issue. I will take this information with me to the next doctor I see. Thanks, > > >> Just a refresher on my sxs. Dec ,2008 woke with a headache and it > >> has not gone away (3 years), new onset of high BP 162-170/100 and > >> found out recently low K (3.1) in 2008. Also tachycardia, sever > >> fatigue, palpatations, dizziness and feeling like I will pass out. > >> Pain in legs ( much like lactic acid build up) going up stairs or > >> inclines, exercise intolerance. Much work up for high BP by > >> cardiologist, many meds, work up by neuro on headaches. I am a > >> physical therapist so I knew to continue to push for an answer as > >> my BP was normal one day and then not the next. Put on ACE and my K > >> was 3.7. 2010 put on Maxide for swelling in the legs after being on > >> a plane, had gained 10 lbs of fluid and K+ dropped. Placed on 20meq > >> and went down again, increased to 40meq. Taken off ACE due to > >> possible cause of burning mouth syndrome and in 1 month my K+ on 40 > >> meq was 2.8. Cardio put me on Spiro but did not want to do any > >> testing. Pushed for tests but current endo I saw said no way I had > >> it. Did find I had hypogammaglobulinemia and started IGg treatments. > >> Got the testing done after being off Spiro for 6 weeks and other BP > >> meds 4 weeks. I tried hard to get 4000mg of sodium for the testing > >> but I do not take in much sodium so I know I kept falling short. > >> Here are the results. My question is since I did not get enough > >> sodium, does this negate the test. I go to a new Endo in 2 weeks, > >> but unsure if they will take me seriously. Been to 4 so far. > >> > Renin is very low 0.33 > Aldo is not 9 mg. > > Your salt excretion is not clear. Is the 163 the excretion of Na in > 24 hrs or the concentration (mM/L). > > Same for the U aldo is it per 24 hr or the concentration. > > If the latter then your ENa is 1.2 x 163 = 195.6 mM so good. > > > > Urine volume 1200 cc x urine Na concentration. > > At the present it appears you have early PA. See my evolution article. > I would recommend DASHing till your urine Na is less than your urine K > and see if your BP and K and you get better. > > Keep us posted. > > CE Grim MD > > >> Renin .33 norm (1.31-3.95) with salt excretion >150 .39-1.31 > >> Aldosterone 9 ng/Dl (0-30), Creatinine .91 Norm. K+ 2.5 (2.5-5.4) > >> Urine testing as follows: Total vol. 1200, creatinine 1.3 (.8-1.8), > >> sodium 163mM (40-220) K+ 30mM (25-125)aldosterone 7 ug/L. > >> From what I have read, it is important to get an excretion of at > >> least 200-250 sodium for the urine tests to be accurate. > >> ANy ideas? >

[Guest guest]

Dr. Grim,

Here are the answers to the following questions you asked.

Please give us the following information again as it is not clear.

My 24 hr urine ENa was __163_ mM/24 hr and my EK was _30_ mM/24 hr

This was on the same day my blood renin and aldo was done. Urine was collected

the day before and turned in the day of blood renin and aldo.

Was an aldosterone measured in this urine? YES, it was 7 Ug/L so that would

mean total volume 1200 ml thus 8.4 Ug/24 hr.

My blood test for renin was __.33 ng/ml/hr and my aldosterone was 9 ng/dl.

My blood K was 3.5 meq/L.

What info was Endo looking at that engendered the statement no way?

The Endo that I went to back in October was looking at labs taken in 2010 when I

was on 3 BP meds and my aldo and renin were tested. The test was ordered by my

primary care's nurse practitioner with a bunch of other tests cause they did not

know what was wrong. They did not give me any prep and the test was done in the

afternoon. My renin then was 1.3 and my aldo was 8. From that information, he

said that no way could I have hyperaldosteronism. He did back a year ago take me

off my meds to rule out Pheo so not sure why he decided I was crazy to think

that meds could have affected these tets. He ordered the new blood tests because

I demanded it and said that I only needed to be off my spiro for 1 week and

could stay on all the other BP meds. That is when I fired him.

I brought your article to my new Endo who is going to do a saline infusion test.

Waiting for it to be scheduled.

Thanks for the reply.

Stacey

>

> > >

> > > >> Just a refresher on my sxs. Dec ,2008 woke with a headache and it

> > > >> has not gone away (3 years), new onset of high BP 162-170/100 and

> > > >> found out recently low K (3.1) in 2008. Also tachycardia, sever

> > > >> fatigue, palpatations, dizziness and feeling like I will pass

> > out.

> > > >> Pain in legs ( much like lactic acid build up) going up stairs or

> > > >> inclines, exercise intolerance. Much work up for high BP by

> > > >> cardiologist, many meds, work up by neuro on headaches. I am a

> > > >> physical therapist so I knew to continue to push for an answer as

> > > >> my BP was normal one day and then not the next. Put on ACE and

> > my K

> > > >> was 3.7. 2010 put on Maxide for swelling in the legs after

> > being on

> > > >> a plane, had gained 10 lbs of fluid and K+ dropped. Placed on

> > 20meq

> > > >> and went down again, increased to 40meq. Taken off ACE due to

> > > >> possible cause of burning mouth syndrome and in 1 month my K+

> > on 40

> > > >> meq was 2.8. Cardio put me on Spiro but did not want to do any

> > > >> testing. Pushed for tests but current endo I saw said no way I

> > had

> > > >> it. Did find I had hypogammaglobulinemia and started IGg

> > treatments.

> > > >> Got the testing done after being off Spiro for 6 weeks and

> > other BP

> > > >> meds 4 weeks. I tried hard to get 4000mg of sodium for the

> > testing

> > > >> but I do not take in much sodium so I know I kept falling short.

> > > >> Here are the results. My question is since I did not get enough

> > > >> sodium, does this negate the test. I go to a new Endo in 2 weeks,

> > > >> but unsure if they will take me seriously. Been to 4 so far.

> > > >>

> > > Renin is very low 0.33

> > > Aldo is not 9 mg.

> > >

> > > Your salt excretion is not clear. Is the 163 the excretion of Na in

> > > 24 hrs or the concentration (mM/L).

> > >

> > > Same for the U aldo is it per 24 hr or the concentration.

> > >

> > > If the latter then your ENa is 1.2 x 163 = 195.6 mM so good.

> > >

> > >

> > >

> > > Urine volume 1200 cc x urine Na concentration.

> > >

> > > At the present it appears you have early PA. See my evolution

> > article.

> > > I would recommend DASHing till your urine Na is less than your

> > urine K

> > > and see if your BP and K and you get better.

> > >

> > > Keep us posted.

> > >

> > > CE Grim MD

> > >

> > > >> Renin .33 norm (1.31-3.95) with salt excretion >150 .39-1.31

> > > >> Aldosterone 9 ng/Dl (0-30), Creatinine .91 Norm. K+ 2.5 (2.5-5.4)

> > > >> Urine testing as follows: Total vol. 1200, creatinine 1.3 (.

> > 8-1.8),

> > > >> sodium 163mM (40-220) K+ 30mM (25-125)aldosterone 7 ug/L.

> > > >> From what I have read, it is important to get an excretion of at

> > > >> least 200-250 sodium for the urine tests to be accurate.

> > > >> ANy ideas?

> > >

> >

> >

>

[Guest guest]

So the saline test perfected by Grim and Weinberger is being done? I have. I I have not done one in since about 1994. To be done properly you need to be in the Hosp the night before and have the infusion start at 8 am after you have been up and walking for 2 hours. And u need to be off all meds for 4-6 weeks. Nevertheless be certain that the measure the volume of pee you pass during the 4 hr infusion. See our intro for details. I don't see your thumbnail yet and need to recall is you have had any attempts at imaging of the adrenal. Because your BP and K got better with MCB as I recall if u were my pt I would just push the DASH ( documented by Urine NA /K to see if your get back to your old self. If that did not work and my ombinAtion of combination treatment program did not get u to normal the then i would do proper saline test. If + then would do AVS WITH ACTH and consider surgery it that was + to one side. Assume u have no FH of HTN LOW K or early strokes in males. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Feb 5, 2012, at 18:28, StaceyF <ssminnow@...> wrote:

Dr. Grim,

Here are the answers to the following questions you asked.

Please give us the following information again as it is not clear.

My 24 hr urine ENa was __163_ mM/24 hr and my EK was _30_ mM/24 hr

This was on the same day my blood renin and aldo was done. Urine was collected the day before and turned in the day of blood renin and aldo.

Was an aldosterone measured in this urine? YES, it was 7 Ug/L so that would mean total volume 1200 ml thus 8.4 Ug/24 hr.

My blood test for renin was __.33 ng/ml/hr and my aldosterone was 9 ng/dl. My blood K was 3.5 meq/L.

What info was Endo looking at that engendered the statement no way?

The Endo that I went to back in October was looking at labs taken in 2010 when I was on 3 BP meds and my aldo and renin were tested. The test was ordered by my primary care's nurse practitioner with a bunch of other tests cause they did not know what was wrong. They did not give me any prep and the test was done in the afternoon. My renin then was 1.3 and my aldo was 8. From that information, he said that no way could I have hyperaldosteronism. He did back a year ago take me off my meds to rule out Pheo so not sure why he decided I was crazy to think that meds could have affected these tets. He ordered the new blood tests because I demanded it and said that I only needed to be off my spiro for 1 week and could stay on all the other BP meds. That is when I fired him.

I brought your article to my new Endo who is going to do a saline infusion test. Waiting for it to be scheduled.

Thanks for the reply.

Stacey

>

> > >

> > > >> Just a refresher on my sxs. Dec ,2008 woke with a headache and it

> > > >> has not gone away (3 years), new onset of high BP 162-170/100 and

> > > >> found out recently low K (3.1) in 2008. Also tachycardia, sever

> > > >> fatigue, palpatations, dizziness and feeling like I will pass

> > out.

> > > >> Pain in legs ( much like lactic acid build up) going up stairs or

> > > >> inclines, exercise intolerance. Much work up for high BP by

> > > >> cardiologist, many meds, work up by neuro on headaches. I am a

> > > >> physical therapist so I knew to continue to push for an answer as

> > > >> my BP was normal one day and then not the next. Put on ACE and

> > my K

> > > >> was 3.7. 2010 put on Maxide for swelling in the legs after

> > being on

> > > >> a plane, had gained 10 lbs of fluid and K+ dropped. Placed on

> > 20meq

> > > >> and went down again, increased to 40meq. Taken off ACE due to

> > > >> possible cause of burning mouth syndrome and in 1 month my K+

> > on 40

> > > >> meq was 2.8. Cardio put me on Spiro but did not want to do any

> > > >> testing. Pushed for tests but current endo I saw said no way I

> > had

> > > >> it. Did find I had hypogammaglobulinemia and started IGg

> > treatments.

> > > >> Got the testing done after being off Spiro for 6 weeks and

> > other BP

> > > >> meds 4 weeks. I tried hard to get 4000mg of sodium for the

> > testing

> > > >> but I do not take in much sodium so I know I kept falling short.

> > > >> Here are the results. My question is since I did not get enough

> > > >> sodium, does this negate the test. I go to a new Endo in 2 weeks,

> > > >> but unsure if they will take me seriously. Been to 4 so far.

> > > >>

> > > Renin is very low 0.33

> > > Aldo is not 9 mg.

> > >

> > > Your salt excretion is not clear. Is the 163 the excretion of Na in

> > > 24 hrs or the concentration (mM/L).

> > >

> > > Same for the U aldo is it per 24 hr or the concentration.

> > >

> > > If the latter then your ENa is 1.2 x 163 = 195.6 mM so good.

> > >

> > >

> > >

> > > Urine volume 1200 cc x urine Na concentration.

> > >

> > > At the present it appears you have early PA. See my evolution

> > article.

> > > I would recommend DASHing till your urine Na is less than your

> > urine K

> > > and see if your BP and K and you get better.

> > >

> > > Keep us posted.

> > >

> > > CE Grim MD

> > >

> > > >> Renin .33 norm (1.31-3.95) with salt excretion >150 .39-1.31

> > > >> Aldosterone 9 ng/Dl (0-30), Creatinine .91 Norm. K+ 2.5 (2.5-5.4)

> > > >> Urine testing as follows: Total vol. 1200, creatinine 1.3 (.

> > 8-1.8),

> > > >> sodium 163mM (40-220) K+ 30mM (25-125)aldosterone 7 ug/L.

> > > >> From what I have read, it is important to get an excretion of at

> > > >> least 200-250 sodium for the urine tests to be accurate.

> > > >> ANy ideas?

> > >

> >

> >

>

[Guest guest]

This procedure sound very much like the one used in backward nations in dungeon for torturing and to extract information out of spying agents & enemies of the tyrant regims!! Max. So the saline test perfected by Grim and Weinberger is being done? I have. I I have not done one in since about 1994. To be done properly you need to be in the Hosp the night before and have the infusion start at 8 am after you have been up and walking for 2 hours. And u need to be off all meds for 4-6 weeks. Nevertheless be certain that the measure the volume of pee you pass during the 4 hr infusion.

[Guest guest]

I Will look at how to get a thumbnail up when I get home from work. Yes,

getting saline test done and no, not going in hospital the night before. Sadly

this doctor has only done this test one other time, I live in an area where

health care is very lacking. I am starting infusion at 8 am and have been off

all meds since original testing in December. I already plan to have the pee

measured from your previous comments to others.

My BP did improve on spiro and k went up a little, but bp was still high. I was

only on 25 mg 1x day and the cardio did not want to increase it. On the other

meds, my bp is labile.

I am working on dashing now. I do have FH of HTN at ages before 35. No male

strokes, mother had a couple low K but now she does not and takes a maxide and

no problems.

Stacey

> > > > >

> > > > > >> Just a refresher on my sxs. Dec ,2008 woke with a headache and it

> > > > > >> has not gone away (3 years), new onset of high BP 162-170/100 and

> > > > > >> found out recently low K (3.1) in 2008. Also tachycardia, sever

> > > > > >> fatigue, palpatations, dizziness and feeling like I will pass

> > > > out.

> > > > > >> Pain in legs ( much like lactic acid build up) going up stairs or

> > > > > >> inclines, exercise intolerance. Much work up for high BP by

> > > > > >> cardiologist, many meds, work up by neuro on headaches. I am a

> > > > > >> physical therapist so I knew to continue to push for an answer as

> > > > > >> my BP was normal one day and then not the next. Put on ACE and

> > > > my K

> > > > > >> was 3.7. 2010 put on Maxide for swelling in the legs after

> > > > being on

> > > > > >> a plane, had gained 10 lbs of fluid and K+ dropped. Placed on

> > > > 20meq

> > > > > >> and went down again, increased to 40meq. Taken off ACE due to

> > > > > >> possible cause of burning mouth syndrome and in 1 month my K+

> > > > on 40

> > > > > >> meq was 2.8. Cardio put me on Spiro but did not want to do any

> > > > > >> testing. Pushed for tests but current endo I saw said no way I

> > > > had

> > > > > >> it. Did find I had hypogammaglobulinemia and started IGg

> > > > treatments.

> > > > > >> Got the testing done after being off Spiro for 6 weeks and

> > > > other BP

> > > > > >> meds 4 weeks. I tried hard to get 4000mg of sodium for the

> > > > testing

> > > > > >> but I do not take in much sodium so I know I kept falling short.

> > > > > >> Here are the results. My question is since I did not get enough

> > > > > >> sodium, does this negate the test. I go to a new Endo in 2 weeks,

> > > > > >> but unsure if they will take me seriously. Been to 4 so far.

> > > > > >>

> > > > > Renin is very low 0.33

> > > > > Aldo is not 9 mg.

> > > > >

> > > > > Your salt excretion is not clear. Is the 163 the excretion of Na in

> > > > > 24 hrs or the concentration (mM/L).

> > > > >

> > > > > Same for the U aldo is it per 24 hr or the concentration.

> > > > >

> > > > > If the latter then your ENa is 1.2 x 163 = 195.6 mM so good.

> > > > >

> > > > >

> > > > >

> > > > > Urine volume 1200 cc x urine Na concentration.

> > > > >

> > > > > At the present it appears you have early PA. See my evolution

> > > > article.

> > > > > I would recommend DASHing till your urine Na is less than your

> > > > urine K

> > > > > and see if your BP and K and you get better.

> > > > >

> > > > > Keep us posted.

> > > > >

> > > > > CE Grim MD

> > > > >

> > > > > >> Renin .33 norm (1.31-3.95) with salt excretion >150 .39-1.31

> > > > > >> Aldosterone 9 ng/Dl (0-30), Creatinine .91 Norm. K+ 2.5 (2.5-5.4)

> > > > > >> Urine testing as follows: Total vol. 1200, creatinine 1.3 (.

> > > > 8-1.8),

> > > > > >> sodium 163mM (40-220) K+ 30mM (25-125)aldosterone 7 ug/L.

> > > > > >> From what I have read, it is important to get an excretion of at

> > > > > >> least 200-250 sodium for the urine tests to be accurate.

> > > > > >> ANy ideas?

> > > > >

> > > >

> > > >

> > >

> >

> >

>