Re: Urine Specific Gravity in PA?

June 21, 2012

We don't usually use the urinary uric acid as an accurate marker or clue to gout, because so many things can cause a rise in urinary uric acid. We'll use the serum or a joint aspirate IF we are going to check, but usually gout is pretty easy diagnosis based on presentation and lab work is often just confirmatory or gotten for something else.

I think that is so odd about the PA telling you "you have" gout, when you had no gout complaints. And a higher uric acid, serum or urine, still isn't "gout" if there are no symptoms. It's just a high uric acid. I know you know this, but I am just venting for you. I wish I could get a clue what is really going on with providers theses days.

I saw this guy at a clinic in Fagstaff last week for some sinus infection (A fellow PA but one who I oddly noticed does not have PA-C or "physician assistant" on his business card, nor does his name badge say PA-C - BTW the C just means board certified if anyone is wondering - and only has hs name, no credentials and he doesn't id himself as a PA which is required) but he talks so fast, and he fills in his own blanks, before you can answer. Like I had a sore throat and congestion and he says "You have the ear pain too," as a statement and I told the guy, "I don't have any ear pain." and he seemed disappointed that he couldn't tell ME how I was actually feeling.

UGH AND DOUBLE UGH.....if I can ever get the money to finish my Phd (I am done with all coursework and all I need is to do my research) I think I want explore this phenomena - why the docs are not wanting to diagose anymore, at all or the right way,they just get you out the door ASAP

From: <jclark24p@...>Subject: Urine Specific Gravity in PA?hyperaldosteronism Date: Wednesday, June 20, 2012, 8:35 PM

Dr. Grim, have you ever used "Urine Specific Gravity" as a marker for PA? I had an appt. today to discuss side effects of T2DM for disability compensation. I met with a PA and he never checked anything he only reviewed my records. When we got to neuropathy he said I hadn't had diabetes long enough, that it took 10 years to see signs of it and that I had gout. (I had never looked gout up so I couldn't argue with him but I can now, I do not have gout!)

I decided to try and establish the first signs of DM and searched Urine Specific Gravity since I remembered that was usually low and I had looked it up once and found diabetes was one of the causes. When I went to Medlineplus to confirm that look at what I found!

Decreased urine specific gravity may be due to:

Aldosteronism (very rare)

Excessive fluid intake

Diabetes insipidus - central

Diabetes insipidus - nephrogenic

Kidney failure

Renal tubular necrosis

Severe kidney infection (pyelonephritis)

I called up all my labs, back to Aug, 2005, and found I had only hit the minimum one time out of 10 different tests! (Normal range = 1.016-1.022, mine 1.005-1.016) The day Cogbill got 0.1 for renin and 5 for aldo (2/22/2007) it was 1.009, how many indicators did she need! (The good thing is that each report has the provider's name so I can ask each of them what they were thinking!)

I wonder if I had something "very rare" back in 2005! I also wonder if this could be a flag to require the doctor to look further! Your thoughts?

June 21, 2012

, my wife had the same reaction as you, " Is he crazy, you don't have any

symptoms of gout! " (She is a hairdresser who has been practicing for ~48 years

- started young! With most of her customers between 70 and 100 I guess she's

seen gout!)

It became apparent he was not there to DX anything, he was simply going to

refute any of my claims because it " wasn't in my file " . I even tried to

convince him that it wasn't my responsibility to write the report! I asked if

toes and foot feeling like novocaine wearing off all the time and toes starting

to curl up were signs of gout. He said no but my discussion with podiatry

wasn't in my records! He never even asked me to remove my shoe, PA's are

allowed to do physical exams aren't they? ;>)

I gave up and decided to let him write his refusal and then I will file an

appeal and show how incompetent he is! I tried!

I was using the test to see if I could estblish when DM " actually started "

because he was " hanging his hat " on a 10 year rule (apparently the book says

neuropathy shows up only after 10 years of DM.)

>

> From: <jclark24p@...>

> Subject: Urine Specific Gravity in PA?

> hyperaldosteronism

> Date: Wednesday, June 20, 2012, 8:35 PM

>

> Â

>

> Dr. Grim, have you ever used " Urine Specific Gravity " as a marker for PA? I

had an appt. today to discuss side effects of T2DM for disability compensation.

I met with a PA and he never checked anything he only reviewed my records. When

we got to neuropathy he said I hadn't had diabetes long enough, that it took 10

years to see signs of it and that I had gout. (I had never looked gout up so I

couldn't argue with him but I can now, I do not have gout!)

> I decided to try and establish the first signs of DM and searched Urine

Specific Gravity since I remembered that was usually low and I had looked it up

once and found diabetes was one of the causes. When I went to Medlineplus to

confirm that look at what I found!

> Decreased urine specific gravity may be due to:

>

> Aldosteronism (very rare)

> Excessive fluid intake

> Diabetes insipidus - central

> Diabetes insipidus - nephrogenic

> Kidney failure

> Renal tubular necrosis

> Severe kidney infection (pyelonephritis)

> I called up all my labs, back to Aug, 2005, and found I had only hit the

minimum one time out of 10 different tests! (Normal range = 1.016-1.022, mine

1.005-1.016) The day Cogbill got 0.1 for renin and 5 for aldo

(2/22/2007) it was 1.009, how many indicators did she need! (The good thing is

that each report has the provider's name so I can ask each of them what they

were thinking!)

> I wonder if I had something " very rare " back in 2005! I also wonder if this

could be a flag to require the doctor to look further! Your thoughts?

>

June 21, 2012

Must be the PA is having second thoughts or went back and looked at his book

again, I just got a call and they have scheduled me for a podiatry appointment.

> >

> > From: <jclark24p@>

> > Subject: Urine Specific Gravity in PA?

> > hyperaldosteronism

> > Date: Wednesday, June 20, 2012, 8:35 PM

> >

> > Â

> >

> > Dr. Grim, have you ever used " Urine Specific Gravity " as a marker for PA? I

had an appt. today to discuss side effects of T2DM for disability compensation.

I met with a PA and he never checked anything he only reviewed my records. When

we got to neuropathy he said I hadn't had diabetes long enough, that it took 10

years to see signs of it and that I had gout. (I had never looked gout up so I

couldn't argue with him but I can now, I do not have gout!)

> > I decided to try and establish the first signs of DM and searched Urine

Specific Gravity since I remembered that was usually low and I had looked it up

once and found diabetes was one of the causes. When I went to Medlineplus to

confirm that look at what I found!

> > Decreased urine specific gravity may be due to:

> >

> > Aldosteronism (very rare)

> > Excessive fluid intake

> > Diabetes insipidus - central

> > Diabetes insipidus - nephrogenic

> > Kidney failure

> > Renal tubular necrosis

> > Severe kidney infection (pyelonephritis)

> > I called up all my labs, back to Aug, 2005, and found I had only hit the

minimum one time out of 10 different tests! (Normal range = 1.016-1.022, mine

1.005-1.016) The day Cogbill got 0.1 for renin and 5 for aldo

(2/22/2007) it was 1.009, how many indicators did she need! (The good thing is

that each report has the provider's name so I can ask each of them what they

were thinking!)

> > I wonder if I had something " very rare " back in 2005! I also wonder if this

could be a flag to require the doctor to look further! Your thoughts?

> >

>

June 22, 2012

Proper testing of SG requires careful control of salt and water intake. They must have checked an first AM urine at NIH?I have never used it for PA. Best time would be first voided urine in AM. I have seen diabetic eye disease before diabetes is clear. I have never heard of a 10 year rule.As we suspect DM is due to low K in PA then you may not really have DM. Also body weight of course drives GTT towards Dx of DM. Can't recall what your HbA1c is. That is the best way to DX in DM IMHO as it is what we use to monitor Rx in DM. CE Grim MDOn Jun 20, 2012, at 8:35 PM, wrote: Dr. Grim, have you ever used "Urine Specific Gravity" as a marker for PA? I had an appt. today to discuss side effects of T2DM for disability compensation. I met with a PA and he never checked anything he only reviewed my records. When we got to neuropathy he said I hadn't had diabetes long enough, that it took 10 years to see signs of it and that I had gout. (I had never looked gout up so I couldn't argue with him but I can now, I do not have gout!)I decided to try and establish the first signs of DM and searched Urine Specific Gravity since I remembered that was usually low and I had looked it up once and found diabetes was one of the causes. When I went to Medlineplus to confirm that look at what I found!Decreased urine specific gravity may be due to: Aldosteronism (very rare) Excessive fluid intake Diabetes insipidus - central Diabetes insipidus - nephrogenic Kidney failure Renal tubular necrosis Severe kidney infection (pyelonephritis)I called up all my labs, back to Aug, 2005, and found I had only hit the minimum one time out of 10 different tests! (Normal range = 1.016-1.022, mine 1.005-1.016) The day Cogbill got 0.1 for renin and 5 for aldo (2/22/2007) it was 1.009, how many indicators did she need! (The good thing is that each report has the provider's name so I can ask each of them what they were thinking!)I wonder if I had something "very rare" back in 2005! I also wonder if this could be a flag to require the doctor to look further! Your thoughts?

June 22, 2012

How about a project that deals with PA?CE Grim MDOn Jun 21, 2012, at 2:15 AM, Bingham wrote: We don't usually use the urinary uric acid as an accurate marker or clue to gout, because so many things can cause a rise in urinary uric acid. We'll use the serum or a joint aspirate IF we are going to check, but usually gout is pretty easy diagnosis based on presentation and lab work is often just confirmatory or gotten for something else. I think that is so odd about the PA telling you "you have" gout, when you had no gout complaints. And a higher uric acid, serum or urine, still isn't "gout" if there are no symptoms. It's just a high uric acid. I know you know this, but I am just venting for you. I wish I could get a clue what is really going on with providers theses days. I saw this guy at a clinic in Fagstaff last week for some sinus infection (A fellow PA but one who I oddly noticed does not have PA-C or "physician assistant" on his business card, nor does his name badge say PA-C - BTW the C just means board certified if anyone is wondering - and only has hs name, no credentials and he doesn't id himself as a PA which is required) but he talks so fast, and he fills in his own blanks, before you can answer. Like I had a sore throat and congestion and he says "You have the ear pain too," as a statement and I told the guy, "I don't have any ear pain." and he seemed disappointed that he couldn't tell ME how I was actually feeling. UGH AND DOUBLE UGH.....if I can ever get the money to finish my Phd (I am done with all coursework and all I need is to do my research) I think I want explore this phenomena - why the docs are not wanting to diagose anymore, at all or the right way,they just get you out the door ASAP From: <jclark24p@...>Subject: Urine Specific Gravity in PA?hyperaldosteronism Date: Wednesday, June 20, 2012, 8:35 PM Dr. Grim, have you ever used "Urine Specific Gravity" as a marker for PA? I had an appt. today to discuss side effects of T2DM for disability compensation. I met with a PA and he never checked anything he only reviewed my records. When we got to neuropathy he said I hadn't had diabetes long enough, that it took 10 years to see signs of it and that I had gout. (I had never looked gout up so I couldn't argue with him but I can now, I do not have gout!) I decided to try and establish the first signs of DM and searched Urine Specific Gravity since I remembered that was usually low and I had looked it up once and found diabetes was one of the causes. When I went to Medlineplus to confirm that look at what I found! Decreased urine specific gravity may be due to: Aldosteronism (very rare) Excessive fluid intake Diabetes insipidus - central Diabetes insipidus - nephrogenic Kidney failure Renal tubular necrosis Severe kidney infection (pyelonephritis) I called up all my labs, back to Aug, 2005, and found I had only hit the minimum one time out of 10 different tests! (Normal range = 1.016-1.022, mine 1.005-1.016) The day Cogbill got 0.1 for renin and 5 for aldo (2/22/2007) it was 1.009, how many indicators did she need! (The good thing is that each report has the provider's name so I can ask each of them what they were thinking!) I wonder if I had something "very rare" back in 2005! I also wonder if this could be a flag to require the doctor to look further! Your thoughts?

June 22, 2012

Not testing your feet with a microfiber is malpractice if DM is present. Should be done regularly in VA system.CE Grim MDOn Jun 21, 2012, at 8:45 AM, wrote: , my wife had the same reaction as you, "Is he crazy, you don't have any symptoms of gout!" (She is a hairdresser who has been practicing for ~48 years - started young! With most of her customers between 70 and 100 I guess she's seen gout!) It became apparent he was not there to DX anything, he was simply going to refute any of my claims because it "wasn't in my file". I even tried to convince him that it wasn't my responsibility to write the report! I asked if toes and foot feeling like novocaine wearing off all the time and toes starting to curl up were signs of gout. He said no but my discussion with podiatry wasn't in my records! He never even asked me to remove my shoe, PA's are allowed to do physical exams aren't they? ;>) I gave up and decided to let him write his refusal and then I will file an appeal and show how incompetent he is! I tried! I was using the test to see if I could estblish when DM "actually started" because he was "hanging his hat" on a 10 year rule (apparently the book says neuropathy shows up only after 10 years of DM.) > > > From: <jclark24p@...> > Subject: Urine Specific Gravity in PA? > hyperaldosteronism > Date: Wednesday, June 20, 2012, 8:35 PM > > > > Â > > > > > Dr. Grim, have you ever used "Urine Specific Gravity" as a marker for PA? I had an appt. today to discuss side effects of T2DM for disability compensation. I met with a PA and he never checked anything he only reviewed my records. When we got to neuropathy he said I hadn't had diabetes long enough, that it took 10 years to see signs of it and that I had gout. (I had never looked gout up so I couldn't argue with him but I can now, I do not have gout!) > I decided to try and establish the first signs of DM and searched Urine Specific Gravity since I remembered that was usually low and I had looked it up once and found diabetes was one of the causes. When I went to Medlineplus to confirm that look at what I found! > Decreased urine specific gravity may be due to: > > > Aldosteronism (very rare) > Excessive fluid intake > Diabetes insipidus - central > Diabetes insipidus - nephrogenic > Kidney failure > Renal tubular necrosis > Severe kidney infection (pyelonephritis) > I called up all my labs, back to Aug, 2005, and found I had only hit the minimum one time out of 10 different tests! (Normal range = 1.016-1.022, mine 1.005-1.016) The day Cogbill got 0.1 for renin and 5 for aldo (2/22/2007) it was 1.009, how many indicators did she need! (The good thing is that each report has the provider's name so I can ask each of them what they were thinking!) > I wonder if I had something "very rare" back in 2005! I also wonder if this could be a flag to require the doctor to look further! Your thoughts? >

June 22, 2012

That has been done by both PCP and Podiatrist in the last year.

> > >

> > > From: <jclark24p@>

> > > Subject: Urine Specific Gravity in PA?

> > > hyperaldosteronism

> > > Date: Wednesday, June 20, 2012, 8:35 PM

> > >

> > > Â

> > >

> > > Dr. Grim, have you ever used " Urine Specific Gravity " as a marker

> > for PA? I had an appt. today to discuss side effects of T2DM for

> > disability compensation. I met with a PA and he never checked

> > anything he only reviewed my records. When we got to neuropathy he

> > said I hadn't had diabetes long enough, that it took 10 years to see

> > signs of it and that I had gout. (I had never looked gout up so I

> > couldn't argue with him but I can now, I do not have gout!)

> > > I decided to try and establish the first signs of DM and searched

> > Urine Specific Gravity since I remembered that was usually low and I

> > had looked it up once and found diabetes was one of the causes. When

> > I went to Medlineplus to confirm that look at what I found!

> > > Decreased urine specific gravity may be due to:

> > >

> > > Aldosteronism (very rare)

> > > Excessive fluid intake

> > > Diabetes insipidus - central

> > > Diabetes insipidus - nephrogenic

> > > Kidney failure

> > > Renal tubular necrosis

> > > Severe kidney infection (pyelonephritis)

> > > I called up all my labs, back to Aug, 2005, and found I had only

> > hit the minimum one time out of 10 different tests! (Normal range =

> > 1.016-1.022, mine 1.005-1.016) The day Cogbill got 0.1 for

> > renin and 5 for aldo (2/22/2007) it was 1.009, how many indicators

> > did she need! (The good thing is that each report has the provider's

> > name so I can ask each of them what they were thinking!)

> > > I wonder if I had something " very rare " back in 2005! I also

> > wonder if this could be a flag to require the doctor to look

> > further! Your thoughts?

> > >

> >

>

June 22, 2012

Good not needed by both as long as both do it the same way.And was it negative?CE Grim MDOn Jun 22, 2012, at 9:02 AM, wrote: That has been done by both PCP and Podiatrist in the last year. > > > > > > > > > From: <jclark24p@> > > > Subject: Urine Specific Gravity in PA? > > > hyperaldosteronism > > > Date: Wednesday, June 20, 2012, 8:35 PM > > > > > > > > > > > > Â > > > > > > > > > > > > > > > Dr. Grim, have you ever used "Urine Specific Gravity" as a marker > > for PA? I had an appt. today to discuss side effects of T2DM for > > disability compensation. I met with a PA and he never checked > > anything he only reviewed my records. When we got to neuropathy he > > said I hadn't had diabetes long enough, that it took 10 years to see > > signs of it and that I had gout. (I had never looked gout up so I > > couldn't argue with him but I can now, I do not have gout!) > > > I decided to try and establish the first signs of DM and searched > > Urine Specific Gravity since I remembered that was usually low and I > > had looked it up once and found diabetes was one of the causes. When > > I went to Medlineplus to confirm that look at what I found! > > > Decreased urine specific gravity may be due to: > > > > > > > > > Aldosteronism (very rare) > > > Excessive fluid intake > > > Diabetes insipidus - central > > > Diabetes insipidus - nephrogenic > > > Kidney failure > > > Renal tubular necrosis > > > Severe kidney infection (pyelonephritis) > > > I called up all my labs, back to Aug, 2005, and found I had only > > hit the minimum one time out of 10 different tests! (Normal range = > > 1.016-1.022, mine 1.005-1.016) The day Cogbill got 0.1 for > > renin and 5 for aldo (2/22/2007) it was 1.009, how many indicators > > did she need! (The good thing is that each report has the provider's > > name so I can ask each of them what they were thinking!) > > > I wonder if I had something "very rare" back in 2005! I also > > wonder if this could be a flag to require the doctor to look > > further! Your thoughts? > > > > > > > >

June 22, 2012

My PCP does it as part of her annual review and often trusts only the Best

doctor at the VA, herself!

> > > > >

> > > > > From: <jclark24p@>

> > > > > Subject: Urine Specific Gravity in PA?

> > > > > hyperaldosteronism

> > > > > Date: Wednesday, June 20, 2012, 8:35 PM

> > > > >

> > > > > Â

> > > > >

> > > > > Dr. Grim, have you ever used " Urine Specific Gravity " as a

> > marker

> > > > for PA? I had an appt. today to discuss side effects of T2DM for

> > > > disability compensation. I met with a PA and he never checked

> > > > anything he only reviewed my records. When we got to neuropathy he

> > > > said I hadn't had diabetes long enough, that it took 10 years to

> > see

> > > > signs of it and that I had gout. (I had never looked gout up so I

> > > > couldn't argue with him but I can now, I do not have gout!)

> > > > > I decided to try and establish the first signs of DM and

> > searched

> > > > Urine Specific Gravity since I remembered that was usually low

> > and I

> > > > had looked it up once and found diabetes was one of the causes.

> > When

> > > > I went to Medlineplus to confirm that look at what I found!

> > > > > Decreased urine specific gravity may be due to:

> > > > >

> > > > > Aldosteronism (very rare)

> > > > > Excessive fluid intake

> > > > > Diabetes insipidus - central

> > > > > Diabetes insipidus - nephrogenic

> > > > > Kidney failure

> > > > > Renal tubular necrosis

> > > > > Severe kidney infection (pyelonephritis)

> > > > > I called up all my labs, back to Aug, 2005, and found I had only

> > > > hit the minimum one time out of 10 different tests! (Normal

> > range =

> > > > 1.016-1.022, mine 1.005-1.016) The day Cogbill got 0.1

> > for

> > > > renin and 5 for aldo (2/22/2007) it was 1.009, how many indicators

> > > > did she need! (The good thing is that each report has the

> > provider's

> > > > name so I can ask each of them what they were thinking!)

> > > > > I wonder if I had something " very rare " back in 2005! I also

> > > > wonder if this could be a flag to require the doctor to look

> > > > further! Your thoughts?

> > > > >

> > > >

> > >

> >

>

June 22, 2012

The VA at least the WRJ VA is having a hard time keeping PCP This is do in part

changes in how money is now budgeted. This has lead to a cutback in PCPs. This

has lead to the ones that do stay being over worked. With them spending 10 to 12

hour a day at work.

If it comes down to you having to appeal make sure you have a A Dr who is a

expert in T2DM that will dispute what this PA is stating. With out this you will

have almost 0 Chance of of winning

> >

> > From: <jclark24p@>

> > Subject: Urine Specific Gravity in PA?

> > hyperaldosteronism

> > Date: Wednesday, June 20, 2012, 8:35 PM

> >

> > Â

> >

> > Dr. Grim, have you ever used " Urine Specific Gravity " as a marker for PA? I

had an appt. today to discuss side effects of T2DM for disability compensation.

I met with a PA and he never checked anything he only reviewed my records. When

we got to neuropathy he said I hadn't had diabetes long enough, that it took 10

years to see signs of it and that I had gout. (I had never looked gout up so I

couldn't argue with him but I can now, I do not have gout!)

> > I decided to try and establish the first signs of DM and searched Urine

Specific Gravity since I remembered that was usually low and I had looked it up

once and found diabetes was one of the causes. When I went to Medlineplus to

confirm that look at what I found!

> > Decreased urine specific gravity may be due to:

> >

> > Aldosteronism (very rare)

> > Excessive fluid intake

> > Diabetes insipidus - central

> > Diabetes insipidus - nephrogenic

> > Kidney failure

> > Renal tubular necrosis

> > Severe kidney infection (pyelonephritis)

> > I called up all my labs, back to Aug, 2005, and found I had only hit the

minimum one time out of 10 different tests! (Normal range = 1.016-1.022, mine

1.005-1.016) The day Cogbill got 0.1 for renin and 5 for aldo

(2/22/2007) it was 1.009, how many indicators did she need! (The good thing is

that each report has the provider's name so I can ask each of them what they

were thinking!)

> > I wonder if I had something " very rare " back in 2005! I also wonder if this

could be a flag to require the doctor to look further! Your thoughts?

> >

>

June 22, 2012

My assessment is that this exam is not a good use of a Dr's time and knowledge. It can be assigned to trained personnel so Dr. has more time to think and manage all problems in the short time allowed in the VA system.CE Grim MDOn Jun 22, 2012, at 9:28 AM, wrote: My PCP does it as part of her annual review and often trusts only the Best doctor at the VA, herself! > > > > > > > > > > > > > > > From: <jclark24p@> > > > > > Subject: Urine Specific Gravity in PA? > > > > > hyperaldosteronism > > > > > Date: Wednesday, June 20, 2012, 8:35 PM > > > > > > > > > > > > > > > > > > > > Â > > > > > > > > > > > > > > > > > > > > > > > > > Dr. Grim, have you ever used "Urine Specific Gravity" as a > > marker > > > > for PA? I had an appt. today to discuss side effects of T2DM for > > > > disability compensation. I met with a PA and he never checked > > > > anything he only reviewed my records. When we got to neuropathy he > > > > said I hadn't had diabetes long enough, that it took 10 years to > > see > > > > signs of it and that I had gout. (I had never looked gout up so I > > > > couldn't argue with him but I can now, I do not have gout!) > > > > > I decided to try and establish the first signs of DM and > > searched > > > > Urine Specific Gravity since I remembered that was usually low > > and I > > > > had looked it up once and found diabetes was one of the causes. > > When > > > > I went to Medlineplus to confirm that look at what I found! > > > > > Decreased urine specific gravity may be due to: > > > > > > > > > > > > > > > Aldosteronism (very rare) > > > > > Excessive fluid intake > > > > > Diabetes insipidus - central > > > > > Diabetes insipidus - nephrogenic > > > > > Kidney failure > > > > > Renal tubular necrosis > > > > > Severe kidney infection (pyelonephritis) > > > > > I called up all my labs, back to Aug, 2005, and found I had only > > > > hit the minimum one time out of 10 different tests! (Normal > > range = > > > > 1.016-1.022, mine 1.005-1.016) The day Cogbill got 0.1 > > for > > > > renin and 5 for aldo (2/22/2007) it was 1.009, how many indicators > > > > did she need! (The good thing is that each report has the > > provider's > > > > name so I can ask each of them what they were thinking!) > > > > > I wonder if I had something "very rare" back in 2005! I also > > > > wonder if this could be a flag to require the doctor to look > > > > further! Your thoughts? > > > > > > > > > > > > > > > > > > > > >

June 22, 2012

Yes I stayed over many hours for which I did not get paid to be sure everything that I felt was needed to be done was done. Not sure all PCPs do this overtime. CE Grim MDOn Jun 22, 2012, at 9:51 AM, Francis Bill SUSPECTED PA wrote: The VA at least the WRJ VA is having a hard time keeping PCP This is do in part changes in how money is now budgeted. This has lead to a cutback in PCPs. This has lead to the ones that do stay being over worked. With them spending 10 to 12 hour a day at work. If it comes down to you having to appeal make sure you have a A Dr who is a expert in T2DM that will dispute what this PA is stating. With out this you will have almost 0 Chance of of winning > > > > > > From: <jclark24p@> > > Subject: Urine Specific Gravity in PA? > > hyperaldosteronism > > Date: Wednesday, June 20, 2012, 8:35 PM > > > > > > > > Â > > > > > > > > > > Dr. Grim, have you ever used "Urine Specific Gravity" as a marker for PA? I had an appt. today to discuss side effects of T2DM for disability compensation. I met with a PA and he never checked anything he only reviewed my records. When we got to neuropathy he said I hadn't had diabetes long enough, that it took 10 years to see signs of it and that I had gout. (I had never looked gout up so I couldn't argue with him but I can now, I do not have gout!) > > I decided to try and establish the first signs of DM and searched Urine Specific Gravity since I remembered that was usually low and I had looked it up once and found diabetes was one of the causes. When I went to Medlineplus to confirm that look at what I found! > > Decreased urine specific gravity may be due to: > > > > > > Aldosteronism (very rare) > > Excessive fluid intake > > Diabetes insipidus - central > > Diabetes insipidus - nephrogenic > > Kidney failure > > Renal tubular necrosis > > Severe kidney infection (pyelonephritis) > > I called up all my labs, back to Aug, 2005, and found I had only hit the minimum one time out of 10 different tests! (Normal range = 1.016-1.022, mine 1.005-1.016) The day Cogbill got 0.1 for renin and 5 for aldo (2/22/2007) it was 1.009, how many indicators did she need! (The good thing is that each report has the provider's name so I can ask each of them what they were thinking!) > > I wonder if I had something "very rare" back in 2005! I also wonder if this could be a flag to require the doctor to look further! Your thoughts? > > >

June 22, 2012

VA can't keep anyone because they don't pay them. I worked for the VA in Salt Lake City. Pay stinks period. Public entities use to sell working for them by saying that benefits were great and made up for low salaries, but unless those benefits start including living allowances, student loan payments, car insurance payments, a million licensing and professional fees now-a-days, and gas for your car, and so on, the worker today, Dr or whatever, need cash to take care of business.

Hard to look past today at a decent retirement as a benefit, as they scare the younger crowd now by telling them even though presume to have a decent retirement, all retirement money goes into someone elses ponzi scheme to be spent as they please in the hopes there's some return and the money's there when you actually do retire. Even me, as young as I am, when I was first married, many of the things we have to have now that cost so much, like car insurance were not mandatory and many went without liability and took their chances. Now, outside of rent and electric, car insurance is the biggest getter of my money - of which right now I have none. So people need to live today. Alot of the people I knew at the VA had spouses who were the main bread winners (many of the women PA's and NP's I knew were married to doctors) and they worked there not needing the money so bad.

But just like Indian Health Services and State run services, benefits rarely matter in the right now when one has massive bills and costs going out. So they can't use great benefits as a selling point anymore.

The VA at least the WRJ VA is having a hard time keeping PCP This is do in part changes in how money is now budgeted. This has lead to a cutback in PCPs. This has lead to the ones that do stay being over worked. With them spending 10 to 12 hour a day at work.If it comes down to you having to appeal make sure you have a A Dr who is a expert in T2DM that will dispute what this PA is stating. With out this you will have almost 0 Chance of of winning > > > > > > From: <jclark24p@>> > Subject: Urine Specific Gravity in PA?> > hyperaldosteronism > > Date: Wednesday, June 20, 2012, 8:35 PM> > > > > > > > Ã‚ > > > > > > > > > > Dr. Grim, have you ever used "Urine Specific Gravity" as a marker for PA?

I had an appt. today to discuss side effects of T2DM for disability compensation. I met with a PA and he never checked anything he only reviewed my records. When we got to neuropathy he said I hadn't had diabetes long enough, that it took 10 years to see signs of it and that I had gout. (I had never looked gout up so I couldn't argue with him but I can now, I do not have gout!)> > I decided to try and establish the first signs of DM and searched Urine Specific Gravity since I remembered that was usually low and I had looked it up once and found diabetes was one of the causes. When I went to Medlineplus to confirm that look at what I found!> > Decreased urine specific gravity may be due to:> > > > > > Aldosteronism (very rare) > > Excessive fluid intake > > Diabetes insipidus - central > > Diabetes insipidus - nephrogenic > > Kidney failure > > Renal

tubular necrosis > > Severe kidney infection (pyelonephritis)> > I called up all my labs, back to Aug, 2005, and found I had only hit the minimum one time out of 10 different tests! (Normal range = 1.016-1.022, mine 1.005-1.016) The day Cogbill got 0.1 for renin and 5 for aldo (2/22/2007) it was 1.009, how many indicators did she need! (The good thing is that each report has the provider's name so I can ask each of them what they were thinking!)> > I wonder if I had something "very rare" back in 2005! I also wonder if this could be a flag to require the doctor to look further! Your thoughts?> >>

June 22, 2012

They pay Registered Nurses extremelyyyyy well.

Phyllis

On 6/22/2012 11:32 AM, Bingham wrote:

Â

VA can't keep anyone because they don't pay

them. I worked for the VA in Salt Lake City. Pay

stinks period. Public entities use to sell

working for them by saying that benefits were

great and made up for low salaries, but unless

those benefits start including living

allowances, student loan payments, car insurance

payments, a million licensing and professional

fees now-a-days, and gas for your car, and so

on, the worker today, Dr or whatever, need cash

to take care of business.

Â

Hard to look past today at a decent

retirement as a benefit, as they scare the

younger crowd now by telling them even though

presume to have a decent retirement, all

retirement money goes into someone elses ponzi

scheme to be spent as they please in the hopes

there's some return and the money's there when

you actually do retire. Even me, as young as I

am, when I was first married, many of the things

we have to have now that cost so much,Â like car

insurance were not mandatory and many went

without liability and took their chances. Now,

outside of rent and electric, car insurance is

the biggest getter of my money - of which right

now I have none. So people need to live today.

Alot of the people I knew at the VA had spouses

who were the main bread winners (many of the

women PA's and NP's I knew were married to

doctors)Â and they worked there not needing the

money so bad.

Â

But just like Indian Health Services and

State run services, benefits rarely matter in

the right now when one has massive bills and

costs going out. So they can't

useÂ greatÂ benefitsÂ as a selling point anymore.

Â

The VA at least the WRJ

VA is having a hard time

keeping PCP This is do in

part changes in how money

is now budgeted. This has

lead to a cutback in PCPs.

This has lead to the ones

that do stay being over

worked. With them spending

10 to 12 hour a day at

work.

If it comes down to you

having to appeal make sure

you have a A Dr who is a

expert in T2DM that will

dispute what this PA is

stating. With out this you

will have almost 0 Chance

of of winning

> >

> > From:

<jclark24p@>

> > Subject:

Urine

Specific Gravity in PA?

> > hyperaldosteronism

> > Date: Wednesday,

June 20, 2012, 8:35 PM

> >

> > Ã‚Â

> >

> > Dr. Grim, have

you ever used "Urine

Specific Gravity" as a

marker for PA? I had an

appt. today to discuss

side effects of T2DM for

disability compensation. I

met with a PA and he never

checked anything he only

reviewed my records. When

we got to neuropathy he

said I hadn't had diabetes

long enough, that it took

10 years to see signs of

it and that I had gout. (I

had never looked gout up

so I couldn't argue with

him but I can now, I do

not have gout!)

> > I decided to try

and establish the first

signs of DM and searched

Urine Specific Gravity

since I remembered that

was usually low and I had

looked it up once and

found diabetes was one of

the causes. When I went to

Medlineplus to confirm

that look at what I found!

> > Decreased urine

specific gravity may be

due to:

> >

> > Aldosteronism

(very rare)

> > Excessive fluid

intake

> > Diabetes

insipidus - central

> > Diabetes

insipidus - nephrogenic

> > Kidney failure

> > Renal tubular

necrosis

> > Severe kidney

infection (pyelonephritis)

> > I called up all

my labs, back to Aug,

2005, and found I had only

hit the minimum one time

out of 10 different tests!

(Normal range =

1.016-1.022, mine

1.005-1.016) The day

Cogbill got 0.1

for renin and 5 for aldo

(2/22/2007) it was 1.009,

how many indicators did

she need! (The good thing

is that each report has

the provider's name so I

can ask each of them what

they were thinking!)

> > I wonder if I

had something "very rare"

back in 2005! I also

wonder if this could be a

flag to require the doctor

to look further! Your

thoughts?

> >

>

June 22, 2012

From USA jobs.

The Durham VA Medical Center is recruiting for a Physician Assistant for Medical

Service. For more information on the Department of Veterans Affairs, go to

http://www.vacareers.va.gov/ .

Agency:

Veterans Affairs, Veterans Health Administration

Location:

Durham,North Carolina

Salary:

$57,222.00 to $109,611.00 / Per Year

> >> > >

> >> > > From: <jclark24p@>

> >> > > Subject: Urine Specific Gravity in PA?

> >> > > hyperaldosteronism

> >>

<http://us.mc1107.mail./mc/compose?to=hyperaldosteronism%40groups.\

com>

> >> > > Date: Wednesday, June 20, 2012, 8:35 PM

> >> > >

> >> > > Ã‚

> >> > >

> >> > > Dr. Grim, have you ever used " Urine Specific Gravity " as a

> >> marker for PA? I had an appt. today to discuss side effects of

> >> T2DM for disability compensation. I met with a PA and he never

> >> checked anything he only reviewed my records. When we got to

> >> neuropathy he said I hadn't had diabetes long enough, that it

> >> took 10 years to see signs of it and that I had gout. (I had

> >> never looked gout up so I couldn't argue with him but I can now,

> >> I do not have gout!)

> >> > > I decided to try and establish the first signs of DM and

> >> searched Urine Specific Gravity since I remembered that was

> >> usually low and I had looked it up once and found diabetes was

> >> one of the causes. When I went to Medlineplus to confirm that

> >> look at what I found!

> >> > > Decreased urine specific gravity may be due to:

> >> > >

> >> > > Aldosteronism (very rare)

> >> > > Excessive fluid intake

> >> > > Diabetes insipidus - central

> >> > > Diabetes insipidus - nephrogenic

> >> > > Kidney failure

> >> > > Renal tubular necrosis

> >> > > Severe kidney infection (pyelonephritis)

> >> > > I called up all my labs, back to Aug, 2005, and found I had

> >> only hit the minimum one time out of 10 different tests! (Normal

> >> range = 1.016-1.022, mine 1.005-1.016) The day Cogbill

> >> got 0.1 for renin and 5 for aldo (2/22/2007) it was 1.009, how

> >> many indicators did she need! (The good thing is that each report

> >> has the provider's name so I can ask each of them what they were

> >> thinking!)

> >> > > I wonder if I had something " very rare " back in 2005! I also

> >> wonder if this could be a flag to require the doctor to look

> >> further! Your thoughts?

> >> > >

> >> >

> >>

> >

>

June 22, 2012

> > >> > >

> > >> > > From: <jclark24p@>

> > >> > > Subject: Urine Specific Gravity in PA?

> > >> > > hyperaldosteronism

> > >>

<http://us.mc1107.mail./mc/compose?to=hyperaldosteronism%40groups.\

com>

> > >> > > Date: Wednesday, June 20, 2012, 8:35 PM

> > >> > >

> > >> > > Ã‚

> > >> > >

> > >> > > Dr. Grim, have you ever used " Urine Specific Gravity " as a

> > >> marker for PA? I had an appt. today to discuss side effects of

> > >> T2DM for disability compensation. I met with a PA and he never

> > >> checked anything he only reviewed my records. When we got to

> > >> neuropathy he said I hadn't had diabetes long enough, that it

> > >> took 10 years to see signs of it and that I had gout. (I had

> > >> never looked gout up so I couldn't argue with him but I can now,

> > >> I do not have gout!)

> > >> > > I decided to try and establish the first signs of DM and

> > >> searched Urine Specific Gravity since I remembered that was

> > >> usually low and I had looked it up once and found diabetes was

> > >> one of the causes. When I went to Medlineplus to confirm that

> > >> look at what I found!

> > >> > > Decreased urine specific gravity may be due to:

> > >> > >

> > >> > > Aldosteronism (very rare)

> > >> > > Excessive fluid intake

> > >> > > Diabetes insipidus - central

> > >> > > Diabetes insipidus - nephrogenic

> > >> > > Kidney failure

> > >> > > Renal tubular necrosis

> > >> > > Severe kidney infection (pyelonephritis)

> > >> > > I called up all my labs, back to Aug, 2005, and found I had

> > >> only hit the minimum one time out of 10 different tests! (Normal

> > >> range = 1.016-1.022, mine 1.005-1.016) The day Cogbill

> > >> got 0.1 for renin and 5 for aldo (2/22/2007) it was 1.009, how

> > >> many indicators did she need! (The good thing is that each report

> > >> has the provider's name so I can ask each of them what they were

> > >> thinking!)

> > >> > > I wonder if I had something " very rare " back in 2005! I also

> > >> wonder if this could be a flag to require the doctor to look

> > >> further! Your thoughts?

> > >> > >

> > >> >

> > >>

> > >

> >

>

June 22, 2012

> > > >> > >

> > > >> > > From: <jclark24p@>

> > > >> > > Subject: Urine Specific Gravity in PA?

> > > >> > > hyperaldosteronism

> > > >>

<http://us.mc1107.mail./mc/compose?to=hyperaldosteronism%40groups.\

com>

> > > >> > > Date: Wednesday, June 20, 2012, 8:35 PM

> > > >> > >

> > > >> > > Ã‚

> > > >> > >

> > > >> > > Dr. Grim, have you ever used " Urine Specific Gravity " as a

> > > >> marker for PA? I had an appt. today to discuss side effects of

> > > >> T2DM for disability compensation. I met with a PA and he never

> > > >> checked anything he only reviewed my records. When we got to

> > > >> neuropathy he said I hadn't had diabetes long enough, that it

> > > >> took 10 years to see signs of it and that I had gout. (I had

> > > >> never looked gout up so I couldn't argue with him but I can now,

> > > >> I do not have gout!)

> > > >> > > I decided to try and establish the first signs of DM and

> > > >> searched Urine Specific Gravity since I remembered that was

> > > >> usually low and I had looked it up once and found diabetes was

> > > >> one of the causes. When I went to Medlineplus to confirm that

> > > >> look at what I found!

> > > >> > > Decreased urine specific gravity may be due to:

> > > >> > >

> > > >> > > Aldosteronism (very rare)

> > > >> > > Excessive fluid intake

> > > >> > > Diabetes insipidus - central

> > > >> > > Diabetes insipidus - nephrogenic

> > > >> > > Kidney failure

> > > >> > > Renal tubular necrosis

> > > >> > > Severe kidney infection (pyelonephritis)

> > > >> > > I called up all my labs, back to Aug, 2005, and found I had

> > > >> only hit the minimum one time out of 10 different tests! (Normal

> > > >> range = 1.016-1.022, mine 1.005-1.016) The day Cogbill

> > > >> got 0.1 for renin and 5 for aldo (2/22/2007) it was 1.009, how

> > > >> many indicators did she need! (The good thing is that each report

> > > >> has the provider's name so I can ask each of them what they were

> > > >> thinking!)

> > > >> > > I wonder if I had something " very rare " back in 2005! I also

> > > >> wonder if this could be a flag to require the doctor to look

> > > >> further! Your thoughts?

> > > >> > >

> > > >> >

> > > >>

> > > >

> > >

> >

>

June 22, 2012

Trust Me, If I have to appeal I expect to win! (I don't often loose!)

> > >

> > > From: <jclark24p@>

> > > Subject: Urine Specific Gravity in PA?

> > > hyperaldosteronism

> > > Date: Wednesday, June 20, 2012, 8:35 PM

> > >

> > > Â

> > >

> > > Dr. Grim, have you ever used " Urine Specific Gravity " as a marker for PA?

I had an appt. today to discuss side effects of T2DM for disability

compensation. I met with a PA and he never checked anything he only reviewed my

records. When we got to neuropathy he said I hadn't had diabetes long enough,

that it took 10 years to see signs of it and that I had gout. (I had never

looked gout up so I couldn't argue with him but I can now, I do not have gout!)

> > > I decided to try and establish the first signs of DM and searched Urine

Specific Gravity since I remembered that was usually low and I had looked it up

once and found diabetes was one of the causes. When I went to Medlineplus to

confirm that look at what I found!

> > > Decreased urine specific gravity may be due to:

> > >

> > > Aldosteronism (very rare)

> > > Excessive fluid intake

> > > Diabetes insipidus - central

> > > Diabetes insipidus - nephrogenic

> > > Kidney failure

> > > Renal tubular necrosis

> > > Severe kidney infection (pyelonephritis)

> > > I called up all my labs, back to Aug, 2005, and found I had only hit the

minimum one time out of 10 different tests! (Normal range = 1.016-1.022, mine

1.005-1.016) The day Cogbill got 0.1 for renin and 5 for aldo

(2/22/2007) it was 1.009, how many indicators did she need! (The good thing is

that each report has the provider's name so I can ask each of them what they

were thinking!)

> > > I wonder if I had something " very rare " back in 2005! I also wonder if

this could be a flag to require the doctor to look further! Your thoughts?

> > >

> >

>

June 22, 2012

BTW, my PCP has promised me she is going nowhere - we discussed that when I was

complaining about " training Phsycharitists " !