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So what did radiologist think was causing low K? Please send results whenu get them. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Jun 27, 2012, at 14:03, Virginia Wall <virgwall@...> wrote:

Hello group! I had my AVS done at 8 am this morning. They worked for a few extra minutes on the right side but got it no problem. ACTH was used and the samples are being sent to mayo clinic. I should know by Monday they said. One interesting thing the radiologist told me. I told him how the endocrinologist offered to let me do surgery removing the right adrenal without AVS because it was so obvious on the CT scan that my right adrenal had a 3 cm adenoma that was causing the problem. The radiologist said in his experience it's the small adenomas that secrete excess hormones, not the big ones. He said he would be surprised if that adenoma is even secreting hormones. Thoughts? Obviously I will know about myself specifically soon enough but I was just wondering if this was true. I don't remember seeing any research on size of adenomas and hormone secretion. Virginia Wall31 year old femaleCurrent K 3.2DASHingAVS completed June 27, 2012 at BJC Hospital St. Louis, MO3 cm adenoma in right adrenalDiagnosed February 2012Low K & High BP since appx. 2007Possible family history of hyperaldosteronismMeds: K Cl 20 meq 2 tabs tidPrenatal vitaminBreastfeeding; 5 month old with G6PDD

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I will definitely include results. The radiologist is inclined to believe I have many small adenomas on one or both sides that are not visible on the CT scan. Of course he realizes this is a theory. VirginiaOn Jun 27, 2012, at 5:04 PM, Clarence Grim <lowerbp2@...> wrote:

So what did radiologist think was causing low K? Please send results whenu get them. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Jun 27, 2012, at 14:03, Virginia Wall <virgwall@...> wrote:

Hello group! I had my AVS done at 8 am this morning. They worked for a few extra minutes on the right side but got it no problem. ACTH was used and the samples are being sent to mayo clinic. I should know by Monday they said. One interesting thing the radiologist told me. I told him how the endocrinologist offered to let me do surgery removing the right adrenal without AVS because it was so obvious on the CT scan that my right adrenal had a 3 cm adenoma that was causing the problem. The radiologist said in his experience it's the small adenomas that secrete excess hormones, not the big ones. He said he would be surprised if that adenoma is even secreting hormones. Thoughts? Obviously I will know about myself specifically soon enough but I was just wondering if this was true. I don't remember seeing any research on size of adenomas and hormone secretion. Virginia Wall31 year old femaleCurrent K 3.2DASHingAVS completed June 27, 2012 at BJC Hospital St. Louis, MO3 cm adenoma in right adrenalDiagnosed February 2012Low K & High BP since appx. 2007Possible family history of hyperaldosteronismMeds: K Cl 20 meq 2 tabs tidPrenatal vitaminBreastfeeding; 5 month old with G6PDD

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Alternatively, it is also possible that the adrenalectomy on 30mm adenoma did not remove it completely L…is it? Max. I will definitely include results. The radiologist is inclined to believe I have many small adenomas on one or both sides that are not visible on the CT scan. Of course he realizes this is a theory. VirginiaOn Jun 27, 2012, at 5:04 PM, Clarence Grim <lowerbp2@...> wrote: So what did radiologist think was causing low K? Please send results whenu get them.

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No adrenalectomy yet. I was just surprised that the radiologist said bigger adenomas usually don't secrete hormones. I hadn't heard that before. Virginia Wall31 year old femaleCurrent K 3.2DASHingAVS completed June 27, 2012 at BJC Hospital St. Louis, MO3 cm adenoma in right adrenalDiagnosed February 2012Low K & High BP since appx. 2007Possible family history of hyperaldosteronismMeds: K Cl 20 meq 2 tabs tidPrenatal vitaminBreastfeeding; 5 month old with G6PDDOn Jun 27, 2012, at 5:32 PM, "Study Circle" <studycircle@...> wrote:

Alternatively, it is also possible that the adrenalectomy on 30mm adenoma did not remove it completely L…is it? Max. I will definitely include results. The radiologist is inclined to believe I have many small adenomas on one or both sides that are not visible on the CT scan. Of course he realizes this is a theory. VirginiaOn Jun 27, 2012, at 5:04 PM, Clarence Grim <lowerbp2@...> wrote: So what did radiologist think was causing low K? Please send results whenu get them.

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I am too on daily dose of 120 mEq K.Cl but my serum K=4.5…of course I also take Spironolactone=100mg/d, and Ramipril=5mg/d …both help keep K J Max, 62M No adrenalectomy yet. I was just surprised that the radiologist said bigger adenomas usually don't secrete hormones. I hadn't heard that before. Virginia Wall31 year old femaleCurrent K 3.2DASHingAVS completed June 27, 2012 at BJC Hospital St. Louis, MO3 cm adenoma in right adrenalDiagnosed February 2012Low K & High BP since appx. 2007Possible family history of hyperaldosteronismMeds: K Cl 20 meq 2 tabs tidPrenatal vitaminBreastfeeding; 5 month old with G6PDD._,___

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Max, can you tell when your K is off? Even when the lab may say it is okay? Just curious.

From: Study Circle <studycircle@...>Subject: RE: Virginia's AVShyperaldosteronism Date: Wednesday, June 27, 2012, 6:11 PM

I am too on daily dose of 120 mEq K.Cl but my serum K=4.5…of course I also take Spironolactone=100mg/d, and Ramipril=5mg/d …both help keep K J

Max, 62M

No adrenalectomy yet. I was just surprised that the radiologist said bigger adenomas usually don't secrete hormones. I hadn't heard that before.

Virginia Wall

31 year old female

Current K 3.2

DASHing

AVS completed June 27, 2012 at BJC Hospital St. Louis, MO

3 cm adenoma in right adrenal

Diagnosed February 2012

Low K & High BP since appx. 2007

Possible family history of hyperaldosteronism

Meds: K Cl 20 meq 2 tabs tid

Prenatal vitamin

Breastfeeding; 5 month old with G6PDD

.._,___

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You haven't heard it before because it is an opinion and I don't believe a fact!

I believe I have seen/heard something about that but I need to look back. At

your age he should be concerned that it might grow and I do remember what they

said about ones > 4 cm!

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> > So what did radiologist think was causing low K? Please send results whenu

get them.

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What do you mean off? With Spirono=25mg/d + K.Cl=180mEq/d still I had trouble reaching K=4.5But when doc increased Spirono=100mg/d + K.Cl=180 mEq/d then K>4.6 and he reduced K.Cl to 120 mEq/d …then after K=~4.5 is steady for several years now J And I learned that Spironolactone was far more effective in normalizing my K than K.Cl J….damn aldosterone L Max, 62M Max, can you tell when your K is off? Even when the lab may say it is okay? Just curious. I am too on daily dose of 120 mEq K.Cl but my serum K=4.5…of course I also take Spironolactone=100mg/d, and Ramipril=5mg/d …both help keep K J Max, 62M

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I mean do you feel it? When it has said it was okay on the labs did you know it was still low or low for you? I know I have had it 4.0, but they way they drew it I knew they were wrong and it was low by the way I felt when I didn't take my K after that. Just curious. I am very sensitive now to how sensitive WE are to a low K, even a mild one, so I was just wondering.

I am too on daily dose of 120 mEq K.Cl but my serum K=4.5…of course I also take Spironolactone=100mg/d, and Ramipril=5mg/d …both help keep K J

Max, 62M

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That's like saying baby rattlers don't have as much venom - not true. They don't have the same volume, but being immature they can't control their bites as well and you may get more venom (often there's a dry bite - where it was a warning and not much or no venom was injected by a mature one). And venom is venom.

I think we all have learned that in medicine.....anything goes!

From: jclark24p <jclark24p@...>Subject: Re: Virginia's AVShyperaldosteronism Date: Wednesday, June 27, 2012, 6:47 PM

You haven't heard it before because it is an opinion and I don't believe a fact! I believe I have seen/heard something about that but I need to look back. At your age he should be concerned that it might grow and I do remember what they said about ones > 4 cm!> > > > > > > > So what did radiologist think was

causing low K? Please send results whenu get them. > > > > > > > > > > > >>

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Yes definitely I feel. 1st of all I take regular monthly blood tests for K, Na, …. 2nd if my K<4 I have nasal inflammation at night and stuffy congested nose that prevents my breathing and I must get up and drink some 25mEq K-Citrate that opens up my nasals in 20 minutes and can sleep. If my K<3.5 I get severe back muscle spasms that cripples me to bed ( I used to have them when doc had not yet  dx PA)… K.Cl also works for nightly nasal congestions but takes 2 hrs L K-Citrate is much quicker for nights but regularly on K-citrate I could not stand the taste after a month of drinking a glass of it 3 times daily! K.Cl goes down without any taste! Also remember that PA causes some heat intolerance (in my case) and that is more discomfort than K being a bit high or low…heat intolerance causes me great restlessness as though I cannot breathe L Max, 62M I mean do you feel it? When it has said it was okay on the labs did you know it was still low or low for you? I know I have had it 4.0, but they way they drew it I knew they were wrong and it was low by the way I felt when I didn't take my K after that. Just curious. I am very sensitive now to how sensitive WE are to a low K, even a mild one, so I was just wondering.What do you mean off? With Spirono=25mg/d + K.Cl=180mEq/d still I had trouble reaching K=4.5But when doc increased Spirono=100mg/d + K.Cl=180 mEq/d then K>4.6 and he reduced K.Cl to 120 mEq/d …then after K=~4.5 is steady for several years now J And I learned that Spironolactone was far more effective in normalizing my K than K.Cl J….damn aldosterone L Max, 62M

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Ok that's what I was thinking. I just wanted to see what you all thought of it...my radiologist must just be speaking from his experience. Virginia Wall31 year old femaleCurrent K 3.2DASHingAVS completed June 27, 2012 at BJC Hospital St. Louis, MO3 cm adenoma in right adrenalDiagnosed February 2012Low K & High BP since appx. 2007Possible family history of hyperaldosteronismMeds: K Cl 20 meq 2 tabs tidPrenatal vitaminBreastfeeding; 5 month old with G6PDDOn Jun 27, 2012, at 6:58 PM, Bingham <jlkbbk2003@...> wrote:

That's like saying baby rattlers don't have as much venom - not true. They don't have the same volume, but being immature they can't control their bites as well and you may get more venom (often there's a dry bite - where it was a warning and not much or no venom was injected by a mature one). And venom is venom.

I think we all have learned that in medicine.....anything goes!

From: jclark24p <jclark24p@...>Subject: Re: Virginia's AVShyperaldosteronism Date: Wednesday, June 27, 2012, 6:47 PM

You haven't heard it before because it is an opinion and I don't believe a fact! I believe I have seen/heard something about that but I need to look back. At your age he should be concerned that it might grow and I do remember what they said about ones > 4 cm!> > > > > > > > So what did radiologist think was

causing low K? Please send results whenu get them. > > > > > > > > > > > >>

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Not really a theory but the most common cause. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Jun 27, 2012, at 15:15, Virginia Wall <virgwall@...> wrote:

I will definitely include results. The radiologist is inclined to believe I have many small adenomas on one or both sides that are not visible on the CT scan. Of course he realizes this is a theory. VirginiaOn Jun 27, 2012, at 5:04 PM, Clarence Grim <lowerbp2@...> wrote:

So what did radiologist think was causing low K? Please send results whenu get them. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Jun 27, 2012, at 14:03, Virginia Wall <virgwall@...> wrote:

Hello group! I had my AVS done at 8 am this morning. They worked for a few extra minutes on the right side but got it no problem. ACTH was used and the samples are being sent to mayo clinic. I should know by Monday they said. One interesting thing the radiologist told me. I told him how the endocrinologist offered to let me do surgery removing the right adrenal without AVS because it was so obvious on the CT scan that my right adrenal had a 3 cm adenoma that was causing the problem. The radiologist said in his experience it's the small adenomas that secrete excess hormones, not the big ones. He said he would be surprised if that adenoma is even secreting hormones. Thoughts? Obviously I will know about myself specifically soon enough but I was just wondering if this was true. I don't remember seeing any research on size of adenomas and hormone secretion. Virginia Wall31 year old femaleCurrent K 3.2DASHingAVS completed June 27, 2012 at BJC Hospital St. Louis, MO3 cm adenoma in right adrenalDiagnosed February 2012Low K & High BP since appx. 2007Possible family history of hyperaldosteronismMeds: K Cl 20 meq 2 tabs tidPrenatal vitaminBreastfeeding; 5 month old with G6PDD

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Nor have I but yours is generous in size.May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Jun 27, 2012, at 15:44, Virginia Wall <virgwall@...> wrote:

No adrenalectomy yet. I was just surprised that the radiologist said bigger adenomas usually don't secrete hormones. I hadn't heard that before. Virginia Wall31 year old femaleCurrent K 3.2DASHingAVS completed June 27, 2012 at BJC Hospital St. Louis, MO3 cm adenoma in right adrenalDiagnosed February 2012Low K & High BP since appx. 2007Possible family history of hyperaldosteronismMeds: K Cl 20 meq 2 tabs tidPrenatal vitaminBreastfeeding; 5 month old with G6PDDOn Jun 27, 2012, at 5:32 PM, "Study Circle" <studycircle@...> wrote:

Alternatively, it is also possible that the adrenalectomy on 30mm adenoma did not remove it completely L…is it? Max. I will definitely include results. The radiologist is inclined to believe I have many small adenomas on one or both sides that are not visible on the CT scan. Of course he realizes this is a theory. VirginiaOn Jun 27, 2012, at 5:04 PM, Clarence Grim <lowerbp2@...> wrote: So what did radiologist think was causing low K? Please send results whenu get them.

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How clear is it you need ramipril?May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Jun 27, 2012, at 16:11, Study Circle <studycircle@...> wrote:

I am too on daily dose of 120 mEq K.Cl but my serum K=4.5…of course I also take Spironolactone=100mg/d, and Ramipril=5mg/d …both help keep K J Max, 62M No adrenalectomy yet. I was just surprised that the radiologist said bigger adenomas usually don't secrete hormones. I hadn't heard that before. Virginia Wall31 year old femaleCurrent K 3.2DASHingAVS completed June 27, 2012 at BJC Hospital St. Louis, MO3 cm adenoma in right adrenalDiagnosed February 2012Low K & High BP since appx. 2007Possible family history of hyperaldosteronismMeds: K Cl 20 meq 2 tabs tidPrenatal vitaminBreastfeeding; 5 month old with G6PDD._,___

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And did you also work on DASH at all?May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Jun 27, 2012, at 16:51, Study Circle <studycircle@...> wrote:

What do you mean off? With Spirono=25mg/d + K.Cl=180mEq/d still I had trouble reaching K=4.5But when doc increased Spirono=100mg/d + K.Cl=180 mEq/d then K>4.6 and he reduced K.Cl to 120 mEq/d …then after K=~4.5 is steady for several years now J And I learned that Spironolactone was far more effective in normalizing my K than K.Cl J….damn aldosterone L Max, 62M Max, can you tell when your K is off? Even when the lab may say it is okay? Just curious. I am too on daily dose of 120 mEq K.Cl but my serum K=4.5…of course I also take Spironolactone=100mg/d, and Ramipril=5mg/d …both help keep K J Max, 62M

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That is a lot of K and some get GI UPSET from it. Never heard the nasal stuffiness story but maybe pts never told me. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Jun 27, 2012, at 16:11, Study Circle <studycircle@...> wrote:

I am too on daily dose of 120 mEq K.Cl but my serum K=4.5…of course I also take Spironolactone=100mg/d, and Ramipril=5mg/d …both help keep K J Max, 62M No adrenalectomy yet. I was just surprised that the radiologist said bigger adenomas usually don't secrete hormones. I hadn't heard that before. Virginia Wall31 year old femaleCurrent K 3.2DASHingAVS completed June 27, 2012 at BJC Hospital St. Louis, MO3 cm adenoma in right adrenalDiagnosed February 2012Low K & High BP since appx. 2007Possible family history of hyperaldosteronismMeds: K Cl 20 meq 2 tabs tidPrenatal vitaminBreastfeeding; 5 month old with G6PDD._,___

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Ramipril was one of the original meds prior to PA dx and after PA dx doc continued it L I guess in order to keep me on daily doses of dry cough so that I don’t feel too good J Max, 62M How clear is it you need ramipril? May your pressure be low! CE Grim MS, MDSpecializing in DifficultHypertensionOn Jun 27, 2012, at 16:11, Study Circle <studycircle@...> wrote: I am too on daily dose of 120 mEq K.Cl but my serum K=4.5…of course I also take Spironolactone=100mg/d, and Ramipril=5mg/d …both help keep K J Max, 62M

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DASH I can say yes but only simplified it to mean reduce salt in food…as explained below: Max.62M HTN (since 1995) L adenoma by NP59 scan. Aldos=1065…2056 [28-860] pmol/L, Renin=6 [<30] ng/L (DX 2009). med combo #79={Spiro=100, Amlo=2x5mg, Indap=2.5mg, Ramip=2x2.5mg,  Metf=2x500mg, Crestor=20mg, Feno=67mg, K.Cl=6x20mEq, Motilium=10mg, B12=1000µg/m}{K=4.5}{not DASHing but low-salt diet just slightly above craving while keeping K/Na ratio constant, heat intolerance, insulin resistance, tingling right leg & hand} And did you also work on DASH at all? May your pressure be low! CE Grim MS, MDSpecializing in DifficultHypertensionOn Jun 27, 2012, at 16:51, Study Circle <studycircle@...> wrote: What do you mean off? With Spirono=25mg/d + K.Cl=180mEq/d still I had trouble reaching K=4.5But when doc increased Spirono=100mg/d + K.Cl=180 mEq/d then K>4.6 and he reduced K.Cl to 120 mEq/d …then after K=~4.5 is steady for several years now J And I learned that Spironolactone was far more effective in normalizing my K than K.Cl J….damn aldosterone L Max, 62M

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Isn't the ACE cough fun?......not. kept me up many a night in my past.

I am too on daily dose of 120 mEq K.Cl but my serum K=4.5…of course I also take Spironolactone=100mg/d, and Ramipril=5mg/d …both help keep K J

Max, 62M

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I learned that nasal inflammation occurs due to too much salt as well as it makes my nasal fluid as hard as concrete that no amount of hot water can below it out J and consequently it was impossible for me to sleep at night until I discovered this…prior to my discovery, my doc prescribed Vaseline rubbing into my nose and also a stupid medical spray that caused headaches and after a while both did not do any good…until I found out salt/K ratio has been high and now with a glass of 25mEq K-citrate my nasal fluid comes back to normal fluidity and inflammation gradually disappears and I can sleep normally J of course all my findings are from you Dr. Grim in discussions of this Group and I am very much grateful to you for all your efforts and comment. Max.62M HTN (since 1995) L adenoma by NP59 scan. Aldos=1065…2056 [28-860] pmol/L, Renin=6 [<30] ng/L (DX 2009). med combo #79={Spiro=100, Amlo=2x5mg, Indap=2.5mg, Ramip=2x2.5mg,  Metf=2x500mg, Crestor=20mg, Feno=67mg, K.Cl=6x20mEq, Motilium=10mg, B12=1000µg/m}{K=4.5}{not DASHing but low-salt diet just slightly above craving while keeping K/Na ratio constant, heat intolerance, insulin resistance, tingling right leg & hand} That is a lot of K and some get GI UPSET from it. Never heard the nasal stuffiness story but maybe pts never told me. May your pressure be low! CE Grim MS, MDSpecializing in DifficultHypertensionOn Jun 27, 2012, at 16:11, Study Circle <studycircle@...> wrote: I am too on daily dose of 120 mEq K.Cl but my serum K=4.5…of course I also take Spironolactone=100mg/d, and Ramipril=5mg/d …both help keep K J Max, 62M

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Fortunately, my dry cough appears and disappears quickly J I hate it in public places because I have to use the cough to scratch my itching throat and sounds like I am a very sick person spreading viruses L Max, 62M Isn't the ACE cough fun?......not. kept me up many a night in my past. Ramipril was one of the original meds prior to PA dx and after PA dx doc continued it L I guess in order to keep me on daily doses of dry cough so that I don’t feel too good J Max, 62M

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So how did you solve the nasal issue exactly? Are you saying that the liquid K has helped you the most? I have had nasal congestion for years and once the night hits I can't breath at all, all night. I'd love to and give anything to solve that one, but my salt is low so it's not too much salt causing it. I thought maybe it had something to do with my teeth being bad since I can't do anything about them until I get back to work as a PA ($ issues). But I hve no idea why and it drives me crazy. I have tried everything.

I am too on daily dose of 120 mEq K.Cl but my serum K=4.5…of course I also take Spironolactone=100mg/d, and Ramipril=5mg/d …both help keep K J

Max, 62M

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Mine is solved with one glass of K-citrate 25mEq…this is extra to all my daily medications. Max, 62M So how did you solve the nasal issue exactly? Are you saying that the liquid K has helped you the most? I have had nasal congestion for years and once the night hits I can't breath at all, all night. I'd love to and give anything to solve that one, but my salt is low so it's not too much salt causing it. I thought maybe it had something to do with my teeth being bad since I can't do anything about them until I get back to work as a PA ($ issues). But I hve no idea why and it drives me crazy. I have tried everything. I learned that nasal inflammation occurs due to too much salt as well as it makes my nasal fluid as hard as concrete that no amount of hot water can below it out J and consequently it was impossible for me to sleep at night until I discovered this…prior to my discovery, my doc prescribed Vaseline rubbing into my nose and also a stupid medical spray that caused headaches and after a while both did not do any good…until I found out salt/K ratio has been high and now with a glass of 25mEq K-citrate my nasal fluid comes back to normal fluidity and inflammation gradually disappears and I can sleep normally J of course all my findings are from you Dr. Grim in discussions of this Group and I am very much grateful to you for all your efforts and comment. Max.62M HTN (since 1995) L adenoma by NP59 scan. Aldos=1065…2056 [28-860] pmol/L, Renin=6 [<30] ng/L (DX 2009). med combo #79={Spiro=100, Amlo=2x5mg, Indap=2.5mg, Ramip=2x2.5mg, Metf=2x500mg, Crestor=20mg, Feno=67mg, K.Cl=6x20mEq, Motilium=10mg, B12=1000µg/m}{K=4.5}{not DASHing but low-salt diet just slightly above craving while keeping K/Na ratio constant, heat intolerance, insulin resistance, tingling right leg & hand}

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Don't have rattlers in Vermont but I remember a neighbor who came across a

family of skunks and thought one of the little ones wouldn't be able to spray

and would make a good pet! (Smelled like she was wrong!)

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> > > So what did radiologist think was causing low K? Please send results whenu

get them.

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> > >

> > >

> > >

> > >

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