Re: Spironolactone = eating pure Fat

[Guest guest]

Not sure why you need Feno if Crestor is working well. Can you give us your lipid numbers over time so I can make a better recommendation and meds and diet you were on over time. DASH strict will often lower lipids, but the choice is yours.And the rice diet and the Ornish diet will as.Again the choice is yours. These eating plans may also allow you to get off Metformin.Again the choice is yours.Will also correct insulin resistance.Again the choice is yours.Spiro not likely related to increase lipids unless you were way volume expanded before and spiro brought you back to normal volume so less water in the blood and it appears lipids went up.CE Grim MDOn Jun 29, 2012, at 7:01 PM, Study Circle wrote: I got a chance to make 4 graphs of my CHOL, HDL, LDL, TRIG and I am surprised to see that since 25mg/d Spiro was increased to 100mg/d all these 4 lipids immediately started to be elevated sharply even with daily doses of Fenofibrate 67mg + Pravastation 40mg L For this reason I am calling Spironolactone = eating pure Fat L Fortunately, last summer I showed similar graphs to my doc and he switched Pravastation 40mg to Crestor 20mg and all the 4 lipid components are dropping sharply J I am concerned now that the combo (Feno+Crestor) is even dropping HDL sharply reaching lower limit of 0.90 mmol/L L and I am again on my toes to find a reasonable medical solution J Any ideas? Thanks all. Max.62M HTN (since < c1995, dx 1999) 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 salt craving while keeping K/Na ratio high, heat intolerance, insulin resistance, tingling right leg & hand reduced by B12}

[Guest guest]

Hi Dr.

Grim,

Feno

was added after I was forced to stop Lipitor due to muscle damage and muscle

pain…it controls TRIG but not other lipid components so Pravastatin was added

10mg…20mg…40mg…but after Spiro increased to 100mg then lipid components started

to climb up!

In the following graphs beginning of each drug name is the start date of that drug: for TRIG: Feno+Crestor looks more effective than Feno+Pravastatin: My concern is for HDL that is declining sharply: Thanks for your comments and advice.

Max.

62M HTN (since < c1995, dx 1999) 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 salt craving while keeping K/Na ratio high, heat

intolerance, insulin resistance, tingling right leg & hand reduced by B12}

> > >> > I got a chance to make 4 graphs of my CHOL, HDL, LDL, TRIG and I am > > surprised to see that since 25mg/d Spiro was increased to 100mg/d > > all these 4 lipids immediately started to be elevated sharply even > > with daily doses of Fenofibrate 67mg + Pravastation 40mg L> >> >> >> > For this reason I am calling Spironolactone = eating pure Fat L> >> >> >> > Fortunately, last summer I showed similar graphs to my doc and he > > switched Pravastation 40mg to Crestor 20mg and all the 4 lipid > > components are dropping sharply J> >> >> >> > I am concerned now that the combo (Feno+Crestor) is even dropping > > HDL sharply reaching lower limit of 0.90 mmol/L L and I am again on > > my toes to find a reasonable medical solution J> >> >> >> > Any ideas?> >> >> >> > Thanks all.> >> >> >> > Max.> >> > 62M HTN (since < c1995, dx 1999) 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=1000�g/m}{K=4.5}{not DASHing but low-salt diet just slightly > > above salt craving while keeping K/Na ratio high, heat intolerance, > > insulin resistance, tingling right leg & hand reduced by B12}> >> >> >> >> >>

[Guest guest]

Hi Dr.

Grim,

Feno

was added after I was forced to stop Lipitor due to muscle damage and muscle

pain…it controls TRIG but not other lipid components so Pravastatin was added

10mg…20mg…40mg…but after Spiro increased to 100mg then lipid components started

to climb up!

In the following graphs beginning of each drug name is the start date of that drug: for TRIG: Feno+Crestor looks more effective than Feno+Pravastatin: My concern is for HDL that is declining sharply: Thanks for your comments and advice.

Max.

62M HTN (since < c1995, dx 1999) 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 salt craving while keeping K/Na ratio high, heat

intolerance, insulin resistance, tingling right leg & hand reduced by B12}

> > >> > I got a chance to make 4 graphs of my CHOL, HDL, LDL, TRIG and I am > > surprised to see that since 25mg/d Spiro was increased to 100mg/d > > all these 4 lipids immediately started to be elevated sharply even > > with daily doses of Fenofibrate 67mg + Pravastation 40mg L> >> >> >> > For this reason I am calling Spironolactone = eating pure Fat L> >> >> >> > Fortunately, last summer I showed similar graphs to my doc and he > > switched Pravastation 40mg to Crestor 20mg and all the 4 lipid > > components are dropping sharply J> >> >> >> > I am concerned now that the combo (Feno+Crestor) is even dropping > > HDL sharply reaching lower limit of 0.90 mmol/L L and I am again on > > my toes to find a reasonable medical solution J> >> >> >> > Any ideas?> >> >> >> > Thanks all.> >> >> >> > Max.> >> > 62M HTN (since < c1995, dx 1999) 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=1000�g/m}{K=4.5}{not DASHing but low-salt diet just slightly > > above salt craving while keeping K/Na ratio high, heat intolerance, > > insulin resistance, tingling right leg & hand reduced by B12}> >> >> >> >> >>

[Guest guest]

Great charts and would like to know how others can do these.I am no so used to thinking in IU. I assume upper dashed lined is upper limit of "normal" and lower one is lower limit.What are your goals up there? Recall that if you DM is due to PA it will go away(mostly) with good Rx with DASH and MCBs.We do not know if DM due to PA/low K has the same risk as DM not due to this.What was your HbA1c at the time of Dx of DM?In the US there is a big warning about not using both statins and fenofibrate. Due to increased risk of the muscle problems you had. Triglycerides are very sensitive to alcohol and diet intake.Do you have a Hx of vascular disease? MI, Stroke etc?Add BMI to your thumbnail. How rigorously did you test the sensitivity of your lipids to diet intake?CE Grim MD On Jun 29, 2012, at 10:42 PM, Study Circle wrote: Hi Dr. Grim, Feno was added after I was forced to stop Lipitor due to muscle damage and muscle pain…it controls TRIG but not other lipid components so Pravastatin was added 10mg…20mg…40mg…but after Spiro increased to 100mg then lipid components started to climb up! In the following graphs beginning of each drug name is the start date of that drug: for TRIG: Feno+Crestor looks more effective than Feno+Pravastatin: My concern is for HDL that is declining sharply: Thanks for your comments and advice.Max.62M HTN (since < c1995, dx 1999) 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 salt craving while keeping K/Na ratio high, heat intolerance, insulin resistance, tingling right leg & hand reduced by B12} > > >> > I got a chance to make 4 graphs of my CHOL, HDL, LDL, TRIG and I am > > surprised to see that since 25mg/d Spiro was increased to 100mg/d > > all these 4 lipids immediately started to be elevated sharply even > > with daily doses of Fenofibrate 67mg + Pravastation 40mg L> >> >> >> > For this reason I am calling Spironolactone = eating pure Fat L> >> >> >> > Fortunately, last summer I showed similar graphs to my doc and he > > switched Pravastation 40mg to Crestor 20mg and all the 4 lipid > > components are dropping sharply J> >> >> >> > I am concerned now that the combo (Feno+Crestor) is even dropping > > HDL sharply reaching lower limit of 0.90 mmol/L L and I am again on > > my toes to find a reasonable medical solution J> >> >> >> > Any ideas?> >> >> >> > Thanks all.> >> >> >> > Max.> >> > 62M HTN (since < c1995, dx 1999) 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=1000�g/m}{K=4.5}{not DASHing but low-salt diet just slightly > > above salt craving while keeping K/Na ratio high, heat intolerance, > > insulin resistance, tingling right leg & hand reduced by B12}> >> >> >> >> >>

[Guest guest]

Great charts and would like to know how others can do these.I am no so used to thinking in IU. I assume upper dashed lined is upper limit of "normal" and lower one is lower limit.What are your goals up there? Recall that if you DM is due to PA it will go away(mostly) with good Rx with DASH and MCBs.We do not know if DM due to PA/low K has the same risk as DM not due to this.What was your HbA1c at the time of Dx of DM?In the US there is a big warning about not using both statins and fenofibrate. Due to increased risk of the muscle problems you had. Triglycerides are very sensitive to alcohol and diet intake.Do you have a Hx of vascular disease? MI, Stroke etc?Add BMI to your thumbnail. How rigorously did you test the sensitivity of your lipids to diet intake?CE Grim MD On Jun 29, 2012, at 10:42 PM, Study Circle wrote: Hi Dr. Grim, Feno was added after I was forced to stop Lipitor due to muscle damage and muscle pain…it controls TRIG but not other lipid components so Pravastatin was added 10mg…20mg…40mg…but after Spiro increased to 100mg then lipid components started to climb up! In the following graphs beginning of each drug name is the start date of that drug: for TRIG: Feno+Crestor looks more effective than Feno+Pravastatin: My concern is for HDL that is declining sharply: Thanks for your comments and advice.Max.62M HTN (since < c1995, dx 1999) 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 salt craving while keeping K/Na ratio high, heat intolerance, insulin resistance, tingling right leg & hand reduced by B12} > > >> > I got a chance to make 4 graphs of my CHOL, HDL, LDL, TRIG and I am > > surprised to see that since 25mg/d Spiro was increased to 100mg/d > > all these 4 lipids immediately started to be elevated sharply even > > with daily doses of Fenofibrate 67mg + Pravastation 40mg L> >> >> >> > For this reason I am calling Spironolactone = eating pure Fat L> >> >> >> > Fortunately, last summer I showed similar graphs to my doc and he > > switched Pravastation 40mg to Crestor 20mg and all the 4 lipid > > components are dropping sharply J> >> >> >> > I am concerned now that the combo (Feno+Crestor) is even dropping > > HDL sharply reaching lower limit of 0.90 mmol/L L and I am again on > > my toes to find a reasonable medical solution J> >> >> >> > Any ideas?> >> >> >> > Thanks all.> >> >> >> > Max.> >> > 62M HTN (since < c1995, dx 1999) 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=1000�g/m}{K=4.5}{not DASHing but low-salt diet just slightly > > above salt craving while keeping K/Na ratio high, heat intolerance, > > insulin resistance, tingling right leg & hand reduced by B12}> >> >> >> >> >>

[Guest guest]

Thanks Dr. Grim.My notes are included:> > >> > > >> > > > I got a chance to make 4 graphs of my CHOL, HDL, LDL, TRIG and I > > am> > > > surprised to see that since 25mg/d Spiro was increased to 100mg/d> > > > all these 4 lipids immediately started to be elevated sharply even> > > > with daily doses of Fenofibrate 67mg + Pravastation 40mg L> > > >> > > >> > > >> > > > For this reason I am calling Spironolactone = eating pure Fat L> > > >> > > >> > > >> > > > Fortunately, last summer I showed similar graphs to my doc and he> > > > switched Pravastation 40mg to Crestor 20mg and all the 4 lipid> > > > components are dropping sharply J> > > >> > > >> > > >> > > > I am concerned now that the combo (Feno+Crestor) is even dropping> > > > HDL sharply reaching lower limit of 0.90 mmol/L L and I am again > > on> > > > my toes to find a reasonable medical solution J> > > >> > > >> > > >> > > > Any ideas?> > > >> > > >> > > >> > > > Thanks all.> > > >> > > >> > > >> > > > Max.> > > >> > > > 62M HTN (since < c1995, dx 1999) 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=1000�g/m}{K=4.5}{not DASHing but low-salt diet just slightly> > > > above salt craving while keeping K/Na ratio high, heat > > intolerance,> > > > insulin resistance, tingling right leg & hand reduced by B12}> > > >> > > >> > > >> > > >> > > >> > >> >> >>

[Guest guest]

Thanks Dr. Grim.My notes are included:> > >> > > >> > > > I got a chance to make 4 graphs of my CHOL, HDL, LDL, TRIG and I > > am> > > > surprised to see that since 25mg/d Spiro was increased to 100mg/d> > > > all these 4 lipids immediately started to be elevated sharply even> > > > with daily doses of Fenofibrate 67mg + Pravastation 40mg L> > > >> > > >> > > >> > > > For this reason I am calling Spironolactone = eating pure Fat L> > > >> > > >> > > >> > > > Fortunately, last summer I showed similar graphs to my doc and he> > > > switched Pravastation 40mg to Crestor 20mg and all the 4 lipid> > > > components are dropping sharply J> > > >> > > >> > > >> > > > I am concerned now that the combo (Feno+Crestor) is even dropping> > > > HDL sharply reaching lower limit of 0.90 mmol/L L and I am again > > on> > > > my toes to find a reasonable medical solution J> > > >> > > >> > > >> > > > Any ideas?> > > >> > > >> > > >> > > > Thanks all.> > > >> > > >> > > >> > > > Max.> > > >> > > > 62M HTN (since < c1995, dx 1999) 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=1000�g/m}{K=4.5}{not DASHing but low-salt diet just slightly> > > > above salt craving while keeping K/Na ratio high, heat > > intolerance,> > > > insulin resistance, tingling right leg & hand reduced by B12}> > > >> > > >> > > >> > > >> > > >> > >> >> >>

[Guest guest]

What I mean by this when your glucose and lipids were found to be "high" how was your response to dietary manipulations tested before meds were tried?With the problems you have had will meds I would discuss with your team about seeing how you can control your DM and lipids with diet by really trying to work on what you eat. Most Drs. are so convinced that pts will not change their eating habits that they move straight to meds.I do not. A FG alone does not the Dx of DM make today.Can you add your other meds to your HbA1c plot to see if there is any possibility of a worsening of FG or HbA1c with the addition or subtraction you lipid or other meds?And consider a trail of dietary manipulation. If you are diet sensitive the changes are evident within a month.Strongly recommend this.you did not mention a Hx of smoking or early heart disease in the family. Before 55 in men and 65 in women.CE Grim MDOn Jun 30, 2012, at 10:09 PM, medstatinternational wrote:> How rigorously did you test the sensitivity of your lipids to diet > intake?

[Guest guest]

What I mean by this when your glucose and lipids were found to be "high" how was your response to dietary manipulations tested before meds were tried?With the problems you have had will meds I would discuss with your team about seeing how you can control your DM and lipids with diet by really trying to work on what you eat. Most Drs. are so convinced that pts will not change their eating habits that they move straight to meds.I do not. A FG alone does not the Dx of DM make today.Can you add your other meds to your HbA1c plot to see if there is any possibility of a worsening of FG or HbA1c with the addition or subtraction you lipid or other meds?And consider a trail of dietary manipulation. If you are diet sensitive the changes are evident within a month.Strongly recommend this.you did not mention a Hx of smoking or early heart disease in the family. Before 55 in men and 65 in women.CE Grim MDOn Jun 30, 2012, at 10:09 PM, medstatinternational wrote:> How rigorously did you test the sensitivity of your lipids to diet > intake?

[Guest guest]

Again are your charts from Excel?How do you get so many plot points if lipids are checked only once a year?CE Grim MDOn Jun 30, 2012, at 10:09 PM, medstatinternational wrote: Thanks Dr. Grim.My notes are included:> > >> > > >> > > > I got a chance to make 4 graphs of my CHOL, HDL, LDL, TRIG and I > > am> > > > surprised to see that since 25mg/d Spiro was increased to 100mg/d> > > > all these 4 lipids immediately started to be elevated sharply even> > > > with daily doses of Fenofibrate 67mg + Pravastation 40mg L> > > >> > > >> > > >> > > > For this reason I am calling Spironolactone = eating pure Fat L> > > >> > > >> > > >> > > > Fortunately, last summer I showed similar graphs to my doc and he> > > > switched Pravastation 40mg to Crestor 20mg and all the 4 lipid> > > > components are dropping sharply J> > > >> > > >> > > >> > > > I am concerned now that the combo (Feno+Crestor) is even dropping> > > > HDL sharply reaching lower limit of 0.90 mmol/L L and I am again > > on> > > > my toes to find a reasonable medical solution J> > > >> > > >> > > >> > > > Any ideas?> > > >> > > >> > > >> > > > Thanks all.> > > >> > > >> > > >> > > > Max.> > > >> > > > 62M HTN (since < c1995, dx 1999) 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=1000�g/m}{K=4.5}{not DASHing but low-salt diet just slightly> > > > above salt craving while keeping K/Na ratio high, heat > > intolerance,> > > > insulin resistance, tingling right leg & hand reduced by B12}> > > >> > > >> > > >> > > >> > > >> > >> >> >>

[Guest guest]

Again are your charts from Excel?How do you get so many plot points if lipids are checked only once a year?CE Grim MDOn Jun 30, 2012, at 10:09 PM, medstatinternational wrote: Thanks Dr. Grim.My notes are included:> > >> > > >> > > > I got a chance to make 4 graphs of my CHOL, HDL, LDL, TRIG and I > > am> > > > surprised to see that since 25mg/d Spiro was increased to 100mg/d> > > > all these 4 lipids immediately started to be elevated sharply even> > > > with daily doses of Fenofibrate 67mg + Pravastation 40mg L> > > >> > > >> > > >> > > > For this reason I am calling Spironolactone = eating pure Fat L> > > >> > > >> > > >> > > > Fortunately, last summer I showed similar graphs to my doc and he> > > > switched Pravastation 40mg to Crestor 20mg and all the 4 lipid> > > > components are dropping sharply J> > > >> > > >> > > >> > > > I am concerned now that the combo (Feno+Crestor) is even dropping> > > > HDL sharply reaching lower limit of 0.90 mmol/L L and I am again > > on> > > > my toes to find a reasonable medical solution J> > > >> > > >> > > >> > > > Any ideas?> > > >> > > >> > > >> > > > Thanks all.> > > >> > > >> > > >> > > > Max.> > > >> > > > 62M HTN (since < c1995, dx 1999) 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=1000�g/m}{K=4.5}{not DASHing but low-salt diet just slightly> > > > above salt craving while keeping K/Na ratio high, heat > > intolerance,> > > > insulin resistance, tingling right leg & hand reduced by B12}> > > >> > > >> > > >> > > >> > > >> > >> >> >>

[Guest guest]

Again are your charts from Excel? [Max] not Excel but several other statistical analysis packages as well as MS Office modules How do you get so many plot points if lipids are checked only once a year? [Max] annually and sometimes 6 or 3 month tests too…but extra points are interpolated for monthly mean values. CE Grim MDOn Jun 30, 2012, at 10:09 PM, medstatinternational wrote: Thanks Dr. Grim.My notes are included:> > >> > > >> > > > I got a chance to make 4 graphs of my CHOL, HDL, LDL, TRIG and I > > am> > > > surprised to see that since 25mg/d Spiro was increased to 100mg/d> > > > all these 4 lipids immediately started to be elevated sharply even> > > > with daily doses of Fenofibrate 67mg + Pravastation 40mg L> > > >> > > >> > > >> > > > For this reason I am calling Spironolactone = eating pure Fat L> > > >> > > >> > > >> > > > Fortunately, last summer I showed similar graphs to my doc and he> > > > switched Pravastation 40mg to Crestor 20mg and all the 4 lipid> > > > components are dropping sharply J> > > >> > > >> > > >> > > > I am concerned now that the combo (Feno+Crestor) is even dropping> > > > HDL sharply reaching lower limit of 0.90 mmol/L L and I am again > > on> > > > my toes to find a reasonable medical solution J> > > >> > > >> > > >> > > > Any ideas?> > > >> > > >> > > >> > > > Thanks all.> > > >> > > >> > > >> > > > Max.> > > >> > > > 62M HTN (since < c1995, dx 1999) 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=1000�g/m}{K=4.5}{not DASHing but low-salt diet just slightly> > > > above salt craving while keeping K/Na ratio high, heat > > intolerance,> > > > insulin resistance, tingling right leg & hand reduced by B12}> > > >> > > >> > > >> > > >> > > >> > >> >> >>

[Guest guest]

Again are your charts from Excel? [Max] not Excel but several other statistical analysis packages as well as MS Office modules How do you get so many plot points if lipids are checked only once a year? [Max] annually and sometimes 6 or 3 month tests too…but extra points are interpolated for monthly mean values. CE Grim MDOn Jun 30, 2012, at 10:09 PM, medstatinternational wrote: Thanks Dr. Grim.My notes are included:> > >> > > >> > > > I got a chance to make 4 graphs of my CHOL, HDL, LDL, TRIG and I > > am> > > > surprised to see that since 25mg/d Spiro was increased to 100mg/d> > > > all these 4 lipids immediately started to be elevated sharply even> > > > with daily doses of Fenofibrate 67mg + Pravastation 40mg L> > > >> > > >> > > >> > > > For this reason I am calling Spironolactone = eating pure Fat L> > > >> > > >> > > >> > > > Fortunately, last summer I showed similar graphs to my doc and he> > > > switched Pravastation 40mg to Crestor 20mg and all the 4 lipid> > > > components are dropping sharply J> > > >> > > >> > > >> > > > I am concerned now that the combo (Feno+Crestor) is even dropping> > > > HDL sharply reaching lower limit of 0.90 mmol/L L and I am again > > on> > > > my toes to find a reasonable medical solution J> > > >> > > >> > > >> > > > Any ideas?> > > >> > > >> > > >> > > > Thanks all.> > > >> > > >> > > >> > > > Max.> > > >> > > > 62M HTN (since < c1995, dx 1999) 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=1000�g/m}{K=4.5}{not DASHing but low-salt diet just slightly> > > > above salt craving while keeping K/Na ratio high, heat > > intolerance,> > > > insulin resistance, tingling right leg & hand reduced by B12}> > > >> > > >> > > >> > > >> > > >> > >> >> >>

[Guest guest]

Is interpolation automatic or do you have to enter it.I have MS office. Can I replicate this or is it something you own and do not wish to share. I think there is a market for this method of displaying a patient's data. CE Grim MDOn Jun 30, 2012, at 10:56 PM, MedStat wrote:[Max] annually and sometimes 6 or 3 month tests too…but extra points are interpolated for monthly mean values.

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Is interpolation automatic or do you have to enter it.I have MS office. Can I replicate this or is it something you own and do not wish to share. I think there is a market for this method of displaying a patient's data. CE Grim MDOn Jun 30, 2012, at 10:56 PM, MedStat wrote:[Max] annually and sometimes 6 or 3 month tests too…but extra points are interpolated for monthly mean values.

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Is interpolation automatic or do you have to enter it.[Max] yes, interpolation is linear and programmed and done automatically for missing data. I have a database of daily input of any data piece that is available for each day…all non daily data like medical test results, doc visit bp readings,….etc are input then missing data points found by interpolation. I need these interpolation points for advanced statistical analysis of cause-effect relationships of medications and my health condition as well as side effects of medications. For example it was by such analysis that I found relation between K and muscle spasms and created the probability chart for 3 degrees of muscle spasm {low, moderate, severe} for various K levels. I have MS office. [Max] you are using Excel then such graphs cab be generated in excel and also programmed to calculate automatically the interpolation points for missing data. One need to input daily information of known factors…the rest is scientific computer programming. Can I replicate this or is it something you own and do not wish to share. [Max] yes can be done in Excel too. My database has one row for each day and each row contains some 400 variable like:· Daily dose of each medication· Syst bp, diast bp, pulse,…bp category (calculated),…· Glucose tests· Lipid tests· Urine tests· Blood tests· …etc. I think there is a market for this method of displaying a patient's data. [Max] doctors in Canada are equipped with a computer database system and can access medical test results of any med lab immediately and create all kinds of charts and graphs during patients visit. It is about two years that my doc does not write any gibberish in his patients’ files but just has to key in all info in his computer system…doctors’ monopoly on patients through gibberish notes seems to be over here J When my doc is on vacation any other temporary doc in his office can immediately follow my medical eRecords. Max, 62M CE Grim MDOn Jun 30, 2012, at 10:56 PM, MedStat wrote:[Max] annually and sometimes 6 or 3 month tests too…but extra points are interpolated for monthly mean values.

[Guest guest]

Is interpolation automatic or do you have to enter it.[Max] yes, interpolation is linear and programmed and done automatically for missing data. I have a database of daily input of any data piece that is available for each day…all non daily data like medical test results, doc visit bp readings,….etc are input then missing data points found by interpolation. I need these interpolation points for advanced statistical analysis of cause-effect relationships of medications and my health condition as well as side effects of medications. For example it was by such analysis that I found relation between K and muscle spasms and created the probability chart for 3 degrees of muscle spasm {low, moderate, severe} for various K levels. I have MS office. [Max] you are using Excel then such graphs cab be generated in excel and also programmed to calculate automatically the interpolation points for missing data. One need to input daily information of known factors…the rest is scientific computer programming. Can I replicate this or is it something you own and do not wish to share. [Max] yes can be done in Excel too. My database has one row for each day and each row contains some 400 variable like:· Daily dose of each medication· Syst bp, diast bp, pulse,…bp category (calculated),…· Glucose tests· Lipid tests· Urine tests· Blood tests· …etc. I think there is a market for this method of displaying a patient's data. [Max] doctors in Canada are equipped with a computer database system and can access medical test results of any med lab immediately and create all kinds of charts and graphs during patients visit. It is about two years that my doc does not write any gibberish in his patients’ files but just has to key in all info in his computer system…doctors’ monopoly on patients through gibberish notes seems to be over here J When my doc is on vacation any other temporary doc in his office can immediately follow my medical eRecords. Max, 62M CE Grim MDOn Jun 30, 2012, at 10:56 PM, MedStat wrote:[Max] annually and sometimes 6 or 3 month tests too…but extra points are interpolated for monthly mean values.

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What I mean by this when your glucose and lipids were found to be " high " how was your response to dietary manipulations tested before meds were tried?[Max] My lipids skyrocketed immediate after starting bp meds in 1999 but doc ignored until 2003-Oct when he prescribed Lipitor first…high Glucose was noted by doc but ignored until PA endo prescribed Metformin early 2010. My response to these was that I imagined that less fat and less sugar would keep me normal…but alas that medications side effects are much more potent than any dietary intake…diet is effective if no medications is taken to disturb body chemistry! With the problems you have had will meds I would discuss with your team about seeing how you can control your DM and lipids with diet by really trying to work on what you eat. [Max] Doctors in Canada are paid by HealthCare and they become like robots only respond to whatever is instructed in the gov manual and ignore all else! Even there is no coordination between family doc and dieticians who may advise otherwise, i.e., family doc does not and is not allowed to consider any remedy other than medication in the mothly published drug list by gov ! Most Drs. are so convinced that pts will not change their eating habits that they move straight to meds.[Max] tell you the truth, if I could follow a good diet recipe I would never have fallen victim to HTN…I guess J I do not. A FG alone does not the Dx of DM make today.[Max] I noticed my GLUCF was marginal even around 1996 when I was trying someone else’s gluc meter but had no clue what I had to do L Can you add your other meds to your HbA1c plot to see if there is any possibility of a worsening of FG or HbA1c with the addition or subtraction you lipid or other meds?[Max] I am surprised that my doc never ever felt alarmed by my hba1c test results and always considered them either normal or marginal but never in the red zone! I guess he is seeing too many overweight patients with glucf>20 J And consider a trail of dietary manipulation. If you are diet sensitive the changes are evident within a month.[Max] my diet is steady and not much and all my BMI>25 comes from my medications…and diet in presence of medications has marginal effect…as I have noticed. Strongly recommend this. you did not mention a Hx of smoking or early heart disease in the family. Before 55 in men and 65 in women.[Max] non-smoker, non-alcoholic, no history of MI…mom had DM at old age due to lack of exercise and working mainly in stationery conditions L Max.62M HTN (since < c1995, dx 1999) 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 salt craving while keeping K/Na ratio high, heat intolerance, insulin resistance, tingling right leg & hand reduced by B12, BMI=30, non-smoker, non-alcoholic, no history of MI} CE Grim MD On Jun 30, 2012, at 10:09 PM, medstatinternational wrote:> How rigor ously did you test the sensitivity of your lipids to diet > intake?

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Never too late to give changing eating habits a chance say `1 month before next visit if everything else is stable. My bet is the Canadian Diabetes and HTN guidelines recommend a good trial of diet first and then when that fails go to meds. CE Grim On Jul 1, 2012, at 10:44 AM, MedStat wrote: What I mean by this when your glucose and lipids were found to be "high" how was your response to dietary manipulations tested before meds were tried?[Max] My lipids skyrocketed immediate after starting bp meds in 1999 but doc ignored until 2003-Oct when he prescribed Lipitor first…high Glucose was noted by doc but ignored until PA endo prescribed Metformin early 2010. My response to these was that I imagined that less fat and less sugar would keep me normal…but alas that medications side effects are much more potent than any dietary intake…diet is effective if no medications is taken to disturb body chemistry! With the problems you have had will meds I would discuss with your team about seeing how you can control your DM and lipids with diet by really trying to work on what you eat. [Max] Doctors in Canada are paid by HealthCare and they become like robots only respond to whatever is instructed in the gov manual and ignore all else! Even there is no coordination between family doc and dieticians who may advise otherwise, i.e., family doc does not and is not allowed to consider any remedy other than medication in the mothly published drug list by gov ! Most Drs. are so convinced that pts will not change their eating habits that they move straight to meds.[Max] tell you the truth, if I could follow a good diet recipe I would never have fallen victim to HTN…I guess J I do not. A FG alone does not the Dx of DM make today.[Max] I noticed my GLUCF was marginal even around 1996 when I was trying someone else’s gluc meter but had no clue what I had to do L Can you add your other meds to your HbA1c plot to see if there is any possibility of a worsening of FG or HbA1c with the addition or subtraction you lipid or other meds?[Max] I am surprised that my doc never ever felt alarmed by my hba1c test results and always considered them either normal or marginal but never in the red zone! I guess he is seeing too many overweight patients with glucf>20 J And consider a trail of dietary manipulation. If you are diet sensitive the changes are evident within a month.[Max] my diet is steady and not much and all my BMI>25 comes from my medications…and diet in presence of medications has marginal effect…as I have noticed. Strongly recommend this. you did not mention a Hx of smoking or early heart disease in the family. Before 55 in men and 65 in women.[Max] non-smoker, non-alcoholic, no history of MI…mom had DM at old age due to lack of exercise and working mainly in stationery conditions L Max.62M HTN (since < c1995, dx 1999) 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 salt craving while keeping K/Na ratio high, heat intolerance, insulin resistance, tingling right leg & hand reduced by B12, BMI=30, non-smoker, non-alcoholic, no history of MI} CE Grim MD On Jun 30, 2012, at 10:09 PM, medstatinternational wrote:> How rigor ously did you test the sensitivity of your lipids to diet > intake?

[Guest guest]

Never too late to give changing eating habits a chance say `1 month before next visit if everything else is stable. My bet is the Canadian Diabetes and HTN guidelines recommend a good trial of diet first and then when that fails go to meds. CE Grim On Jul 1, 2012, at 10:44 AM, MedStat wrote: What I mean by this when your glucose and lipids were found to be "high" how was your response to dietary manipulations tested before meds were tried?[Max] My lipids skyrocketed immediate after starting bp meds in 1999 but doc ignored until 2003-Oct when he prescribed Lipitor first…high Glucose was noted by doc but ignored until PA endo prescribed Metformin early 2010. My response to these was that I imagined that less fat and less sugar would keep me normal…but alas that medications side effects are much more potent than any dietary intake…diet is effective if no medications is taken to disturb body chemistry! With the problems you have had will meds I would discuss with your team about seeing how you can control your DM and lipids with diet by really trying to work on what you eat. [Max] Doctors in Canada are paid by HealthCare and they become like robots only respond to whatever is instructed in the gov manual and ignore all else! Even there is no coordination between family doc and dieticians who may advise otherwise, i.e., family doc does not and is not allowed to consider any remedy other than medication in the mothly published drug list by gov ! Most Drs. are so convinced that pts will not change their eating habits that they move straight to meds.[Max] tell you the truth, if I could follow a good diet recipe I would never have fallen victim to HTN…I guess J I do not. A FG alone does not the Dx of DM make today.[Max] I noticed my GLUCF was marginal even around 1996 when I was trying someone else’s gluc meter but had no clue what I had to do L Can you add your other meds to your HbA1c plot to see if there is any possibility of a worsening of FG or HbA1c with the addition or subtraction you lipid or other meds?[Max] I am surprised that my doc never ever felt alarmed by my hba1c test results and always considered them either normal or marginal but never in the red zone! I guess he is seeing too many overweight patients with glucf>20 J And consider a trail of dietary manipulation. If you are diet sensitive the changes are evident within a month.[Max] my diet is steady and not much and all my BMI>25 comes from my medications…and diet in presence of medications has marginal effect…as I have noticed. Strongly recommend this. you did not mention a Hx of smoking or early heart disease in the family. Before 55 in men and 65 in women.[Max] non-smoker, non-alcoholic, no history of MI…mom had DM at old age due to lack of exercise and working mainly in stationery conditions L Max.62M HTN (since < c1995, dx 1999) 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 salt craving while keeping K/Na ratio high, heat intolerance, insulin resistance, tingling right leg & hand reduced by B12, BMI=30, non-smoker, non-alcoholic, no history of MI} CE Grim MD On Jun 30, 2012, at 10:09 PM, medstatinternational wrote:> How rigor ously did you test the sensitivity of your lipids to diet > intake?

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Br J Clin Pharmacol. 2009 Oct;68(4):634-7.Short term effects of spironolactone on blood lipid profile: a 3-month study on a cohort of young women with hirsutism.Nakhjavani M, Hamidi S, Esteghamati A, Abbasi M, Nosratian-Jahromi S, Pasalar P.SourceEndocrinology and Metabolism Research Centre (EMRC), Vali-Asr Hospital, Tehran, Iran. nakhjavanim@...AbstractAIMS: To investigate the effects of spironolactone on serum lipids in women with hirsutism over a 3-month period.METHODS: In

a prospective setting, 27 hirsute women (20 with polycystic ovary syndrome and seven with idiopathic hirsutism) with a mean age of 23.0 +/- 5.1 years were studied at baseline and 3 months after receiving a daily dose of 100 mg of spironolactone. Patients did not receive any other medications and did not go through a specific diet during the study. Lipid profile, fasting blood glucose, testosterone, dehydroepiandrosterone sulphate (DHEAS) and prolactin (PRL) were measured at baseline and 3 months after therapy.RESULTS: Mean

body mass index of patients was 26.1 +/- 5.1 kg m(-2) before treatment and 25.9 +/- 5.7 kg m(-2) after treatment (NS). The therapy was associated with a significant decline of mean high-density lipoprotein (HDL),

39.5 mg dl(-1)[95% confidence interval (CI) 35.6, 43.4]vs. 32.2 mg dl(-1) (95% CI 29.2, 35.2), and a significant increase in mean low-density lipoprotein (LDL), 133.1 mg dl(-1) (95% CI 120.2, 146) vs. 150.8 mg dl(-1) (95% CI 139.1, 162.5), and cholesterol/HDL

ratio, 5 (95% CI 4.4, 5.6) vs. 6.4 (95% CI 5.7, 7.1) (P < 0.05). No significant change was noted in total cholesterol, triglyceride or fasting blood glucose levels. Serum values of testosterone, DHEAS and PRL decreased significantly after 3 months of therapy (P < 0.05).CONCLUSIONS: Spironolactone might have adverse effects on serum lipoprotein levels by increasing LDL and decreasing HDL

over a short course of treatment. While treating hirsutism with spironolactone, special care should be given to women with metabolic disorders such as dyslipidaemia.PMID:19843067 [PubMed - indexed for MEDLINE] PMCID:PMC2780289Free PMC Article