Adrenal Insufficiency Testing?

[roxie60]

Just finished paying bills. Took BP and P 104/79 and pulse 110

I need to understand the push pressure?? more I thinl that is Valentijn called it. looks like right now it is 25.

 

[roxie60]

The LabCorp range goes from 7-63 for ACTH.

ACTH is a very fussy test and I'm a little concerned about the lab since you've had to go back so many times. It has to go immediately to a chilled tube and be spun down or it will degrade very quickly. So hopefully they did this!

Ema

I hope so too, there were instructions that told them how to handle each test tube collected. But I did find out that the local lab and the Drs are at odds with each other for some reason so Drs are asking these blood draws be sent to another lab so I think the local lab is getting miffed. I was told the reason I had to come back in was my blood got mixed up in a bag with another guys. Unfriggen believable, here they are dealing with the most part very sick people and they make a mistake like that which requires the energy to drive back (and the cost). I really dont have confidence and how would I know if they handed it properly.

 

[roxie60]

Ema just read the instructions and all it says is draw two lavendar viles and immediately send in wet ice to lab. Well I gave the sample at 7AM and they told me it would not goto Chicago lab until 6PM (then there is at minimum 2.5 hr drive. So I'm not sure how confident I am in what is going on. I prese the results would be scewed if not handled properly?

Wow I really cant read anymore or is that comprehend, just re-read a third time and it says to separate plasma from cells and freeze asap if transporting.

 

[roxie60]

I did not get the CRH test. The nurse could ot find it.

 

[roxie60]

Here is the one that says below 6 is definitive for adrenal insufficiency (panel 4 on page 6):

(You have to convert units by dividing by 27)

got it (how did u know to divide by 27?). Now if ACTH (provided it was handled properly, I'm going to call the nurse and ask her to call the lab and request tie stamps for each vile when they were spun down and frozen).

Now if the ACTH comes in at 22 or higher then I guess I have entered a new club but at least I'l know what I'm battling.

You said this can be dangerous and need to recognize being in an AI crisis. I have never heard of AI until we started this thread. I think I need to know what the symps are of AI crisis. I feel my body has been in crisis for over two weeks. This has happened before. I'm afraid whatever I have is going to kill me before I get any answers or a chance at healing. Guess if I'm dead my company no longer will have to fight against ltd, Im sure they will be relieved since I only seem to be a number and a few pages of opinions (some from people who have had little contact with me).

 

[Ema]

Do you have a disability lawyer? If you are fighting a LTD company, you need one.

There are charts that give you the factor to use when converting units. They are different for every test.

 

[Ema]

The symptoms of an adrenal crisis are extreme dizziness, spaciness, nausea, back or flank pain, diarrhea, rapid heart rate, sweating and low blood pressure.

There are others but those are the biggies. If you feel panicky but ready to pass out, that's usually the start.

Ema

 

[Valentijn]

Just finished paying bills. Took BP and P 104/79 and pulse 110

I need to understand the push pressure?? more I thinl that is Valentijn called it. looks like right now it is 25.

It's "pulse pressure", and yup, yours works out to 25, which is definitely Too Low.

 

[roxie60]

Thanks I had never heard of this as a health indicator.

Pulse pressure: An indicator of heart health?

What is pulse pressure? How important is pulse pressure to your overall health?

Answer

from Sheldon G. Sheps, M.D.​

Blood pressure readings are given in two numbers. The top number is the maximum pressure your heart exerts while beating (systolic pressure), and the bottom number is the amount of pressure in your arteries between beats (diastolic pressure). The numeric difference between your systolic and diastolic blood pressure is called your pulse pressure. For example, if your resting blood pressure is 120/80 millimeters of mercury (mm Hg), your pulse pressure is 40 — which is considered a normal and healthy pulse pressure.
A high pulse pressure may be a strong predictor of heart problems, especially for older adults. Generally, a pulse pressure greater than 40 mm Hg is abnormal. A pulse pressure lower than 40 may mean you have poor heart function, while a higher pulse pressure may mean your heart's valves are leaky (valve regurgitation).
The most important cause of elevated pulse pressure is stiffness of the aorta, the largest artery in the body. The stiffness may be due to high blood pressure or fatty deposits on the walls of the arteries (atherosclerosis). The greater your pulse pressure, the stiffer and more damaged the vessels are thought to be. Other conditions — including severe iron deficiency (anemia) and overactive thyroid (hyperthyroidism) — can increase pulse pressure as well.

 

[roxie60]

Well here is one Dr that doesnt think pulse pressure is significant unless one is having a heart 'incident' - REALLY

I kinda like Amy taking the prior Dr to task, I read his comment (not included) here and thought he was very arrogant and did not give good advice.

moneysaver3 - Wed Jun 30, 2010 7:51 pm

http://doctorslounge.com/cardiology/forums/backup/topic-22193.html#​

John,

Might I suggest that you only give advice if you are 100% sure what the poster is talking about?

She is not talking about low BLOOD PRESSURE. She is talking about low PULSE PRESSURE. There is a difference. A HUGE difference.

Also, it's not really a good idea to tell someone to quit being stressed and to quit focusing on their body! That's not your job! You have not seen that person personally and shouldn't be saying such things!

The reality is that low PULSE pressure (which she CLEARLY DOES have) IS something that can be of concern. It might not be, but it CAN be!

Amy
Dr. Tamer Fouad - Sat Jul 03, 2010 6:20 am

​

Hello Amy!

Thank you for your input. However, I am a little disappointed at the way you chose to express your concern and opinion. John, like everyone else here is a volunteer that tries his best to answer questions to the best of his knowledge for free. His work here is appreciated by everyone.

You have made an interesting comment which is why I am responding back. The definition of pulse pressure is directly related to blood pressure. The pulse pressure is defined as the systolic minus the diastolic pressure. One definition of the normal range for pulse pressure is between 25-50% of systolic blood pressure. Widened (elevated) pulse pressure is much more important with blood pressure readings taken from the general population (screening). These can indicate stiffening of the major arteries or conditions with increased cardiac output / hyperdynamic circulation.

In contrast, a low pulse pressure (definitions in the literature vary from 40 to 45mmHg) is only relevant in the setting of acute decompensated heart failure and possibly also in congestive heart failure. But, let me stress: in these two settings the low pulse pressure is important not from a diagnostic point of view but only from a prognostic angle. We NEVER diagnose these conditions by using low pulse pressure. This is because low pulse pressure is neither specific nor sensitive as a diagnostic test for these conditions. However, the finding of low pulse pressure in a patient with acute decompensated heart failure is related to the patient's expected survival as suggested by some studies.

There are three issues with the post that I am sure John was completely aware of when assessing his response to this question.

First, the notorious inaccuracy of home blood pressure readings. In order to assume that a patient has any blood pressure disorder this should be done by trained personnel using a professional blood pressure reading device.

Second, the lack of consistency in the readings is extremely important. When we say low pulse pressure has a prognostic significance in patients with heart failure we mean a CONSISTENTLY low pulse pressure.

Third, for the sake of the argument, were we to assume the patient has a clinically significant and consistent low pulse pressure and that this COULD be somehow related to something as serious as heart failure then other symptoms would predominate. The patient must have a significantly low blood pressure and a very rapid heart rate. In addition to other failure symptoms such as shortness of breath, etc.

Let me take this opportunity to insist that no one here offers any medical advice. We hope to educate and inform our visitors by answering their questions.

 

[roxie60]

Do you have a disability lawyer? If you are fighting a LTD company, you need one.

There are charts that give you the factor to use when converting units. They are different for every test.

Ive talked to one but since this is ERISA LTD he will do nothing until company denies ltd claim which at the rate they are going will be after they fire me which means they will not have to deal with the claim.

 

[Valentijn]

In contrast, a low pulse pressure (definitions in the literature vary from 40 to 45mmHg) is only relevant in the setting of acute decompensated heart failure and possibly also in congestive heart failure.

It sounds like the MD has a bad case of "quoting from basic textbooks". I'd like to see how "irrelevant" he'd think low pulse pressure is when living with it at 25 and below on a regular basis Most of the medical literature only talks about low pulse pressure terms of heart failure, but if it's low enough, you're still in very bad shape, whether or not heart failure is involved.

And what a bunch of BS about the home BP monitors. Doctors are using the same ones in their offices, and have just as much trouble detecting my pulse. Same thing when they're doing it the old-fashioned way, pumping the bulb to blow up the cuff, and listening for the heart beat.

Also love the "it's not important unless you're having these other symptoms too" line. Even if that were true, when having the "other symptoms", it all still gets dismissed because high blood pressure is the only thing that they understand or care about.

 

[roxie60]

The neuropsch IME is over. I was there from 815AM (it was a 1/2 mile fr home) got back home just before 5PM. I started hurting (muscles/joints/tingling) within an hour. I also could not sleep last night (was tired but wired, also had IBS issues hit about 4AM) got about an hour of sleep, thought I would have been in worse shape but going I was just tired. After an hour started hurting all over, aching. I felt the Dr was professional throughout (better than experience with first IME Dr).

I really wonder how conclusions can be draw from these tests without having a baseline from when I was functioning well. Anyway I did well on some of the tests and did horrible on ones that should have been easy. The one that I struggled with and really surprised me was he said a letter and I was suppose to think of any words that started with that letter excluding pronouns and formal names. I was stunned at how I could not think of words, I use to get teased about being wordy. Th letter 'A' I thik all I could think of was 4 words, 4 friggen words, I sat there and my brain was like a black hole, I could not think of anything after the four words, I felt like I was trying to find words but was stuck in darkness.

Yet when he would show me 50 pics of items then I had to pick the item from 2 on a page I did very well. I'm curious what his evaluation will be. I could tell how far I have fallen just not sure he knows since he does not know me, But I think these tests are desinged to figure out what part of your brain is not working. I also struggle with remembing images in an array and then having to find the images in a stack of cards and place then in the array, I dont feel I did wel on that except for the first one set of 4 images.

I struggled with the pairing of words, he went thru a list of paired words and then he would mention one of the pairs and I had to mention the other word. We went through this mustiple times and I struggled with more than I think I should have. Then we went onto other tests, sometime later he came back to this list of paired words and this time I was able to pair correctly more of the words than the first four times we went thru them. kinda baffles me, for some reason I cant remember immediate things but after some time passes I do better at recalling the missing word in the pair than I did initially. That sounds to me like a short term processing issue, will be interesting to hear his interpretation.

Really physically struggling by noon, had to alternate standing and sitting. Had a banana. Through the rest of the afternoon sturggled with body aches and mental exhaustion. by the time I got to the MMPI(?) there were over 500 questions (some I really did not get, I acctually had to ask him what playing 'house' meant (maybe it was the fatigue). The question was something like did you as a child like playing 'house' (it was in quotes) and I realy had no idea what the question was asking but as soon as he said pretening to have a family then I understood.

There was another MMPI like test of about 300 questions. These were the last tests and I was hurting and so tired I dont even recall what I answered for the 400 questions, I wsa finding it harder to understand the questions that had more than 7 words, rereading them. Cant say the last test is too valid cause I was just tryig to finish it so get done.

Got into my car just feeling like I wanted to fall over (amyone else have the sensation of wanting to fall over from exhaustion or lay doen but still keep going?) I felt naucious when I got home, fixed a frozen dinner and immediately went to bed. S;ept for 3.5 hrs. Woke up cause hot, still hurting all over and stomach updet. It will take a ,onth for his evaluation and will probably take another couple of weeks for me to get a copy. Unfortunately my company says they can fire me in two weeks. I feel like between a rock and a hard place. I had a comforting devotion this morning before I went to the IME so I need to cling to what I read. I dont know how I did, I thik I did poorly on some tests I dont think 3 years ago I would have struggled with, I did fine with some of the tests.

 

[Little Bluestem]

More on pulse pressure and interesting that I might be hypothyroid. I learn so much here at PR, what a great group of peeps.

Heart Rhythm

• When your pulse is low, it means your heart rate is low, and that means your heart is having to work harder to pump your blood. Low pulse rate can be caused by a disruption of the electrical impulses that keep your heart in rhythm. If your blood pressure also drops, it could result in cardiac arrest. If you experience loss of energy, weakness and fainting, along with a low pulse rate, you should seek immediate medical assistance.

Hypothyroidism

• Low thyroid function is called hypothyroidism. Low pulse rate is among the many symptoms of hypothyroidism. When your thyroid gland fails to produce enough of the hormones necessary for your normal bodily functions, your body slows down. Left untreated, hypothyroidism can result in more serious conditions, such as diabetes, high blood pressure, depression and weight problems.

Read more: http://www.ehow.com/about_5076516_causes-low-pulse-rate.html#ixzz2c72XkFZi

These are about pulse rate rather than pulse pressure.

 

[Little Bluestem]

Ive talked to one but since this is ERISA LTD he will do nothing until company denies ltd claim which at the rate they are going will be after they fire me which means they will not have to deal with the claim.

If they fire you and then try to stop processing the claim that has already been filed, I think you should get back to the lawyer.

 

[roxie60]

This one says below 3.7:

http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2265.1987.tb00780.x/abstract

Ema

Sorry Ema I'm not seeing the 3.7 in this abstract, ont have access the PDF, is it in the body of the study?

 

[roxie60]

I wonder what would be the singl best article / commentary to give on Integrative health dr to see the lab ranges are too high and my values need to be taken more seriously. Thyroid, Cortisol something that will help lead to a dx and useful treatment

 

[roxie60]

These are about pulse rate rather than pulse pressure.

Sorrym your right, I wa getting fuzzy

 

[roxie60]

If I am gaining/keeping weight on and not losing weight would that not rule out having AI and more infavor of hypothyroidism?

The difference is patients with adrenal insufficiency tend to lose weight and get dehydrated, while hypothyroid patients gain weight and retain fluids.

 

[Little Bluestem]

What would happen if you had both?