September 3, 2002

The phone rang this morning at 8:30 AM.  I, of course, was still deep under the covers hoping for at least another hour of sleep after a very restless night.  It was the secretary from No Name’s office.  She told me that No Name wanted to see me as soon as possible and asked me if I could come in this afternoon.  I agreed.

I spent the morning tidying up the house; seems long weekends play havoc with a house.  My agenda for the next few weeks is to finish recording a select number of old LP’s into my computer, cleaning up the music and burning the songs to CD’s.  I also want to start uploading the videos I have taken with my digital video camera, editing them and then burning them to DVD’s and VSH. So far I have recorded two old LP’s and burned them onto CD’s.  I have been very impressed with the results.  The software I am using cleans up a lot of the static; beeps and crackles you hear on old recordings.

My appointment with No Name was scheduled for 1:45 PM and I arrived on time, good girl that I am.  No Name informed me that a few of my test results were back.

After a discussion of the lab results, No Name handed me a copy of a letter from NotSoFine.  Apparently No Name had sent him a second letter detailing more lab results.  This letter was NotSoFine’s reply.  I must add here that I have never seen or spoken to NotSoFine. NotSoFine’s opinions are based on the letters he is receiving from No Name and his vivid imagination.

NotSoFine’s letter reads and I quote, “Thanks for the data; this allows some narrowing down of the possibilities.  On those values with serum potassium of 2.8 she definitely has an inappropriate renal response in that she was still pumping potassium out in her urine.  That is to say the hypokalemia was not due to re-distribution of potassium nor GI loss but related to excess aldosterone.  The question is, is that primary aldosternism or secondary or possibly she has RTA (renal tubular acidosis)?   I note the initial values show that the chloride is 91 and the bicarbonate is 28.  This more or less rules out RTA.  She had a slight increase in the urea/creatinine ratio.  Taking all this together would narrow the diagnosis down to vomiting-induced secondary hyperaldosternism or diuretic usage.  The best plan is to watch her.  Could you get her off diuretics?”

After my visit with No Name I headed down to the lab at the clinic to talk to the lab technician.  She told me that she had researched the ACTH test and that she would be able to do it at the clinic lab.  I was very impressed.  We made arrangements for me to come in on Thursday morning at 8:30 AM to have the ACTH, the renin/aldosterone, and a repeat of the AM/PM cortisol done.  She will do the fasting blood sugar and insulin the following week.   What a relief to have finally found a lab technician who is willing to do these tests.

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