22 February 2011
Dr. Brent Michael
2001 Santa Monica Blvd., Ste. 1260W
Santa Monica, CA 90404
cc: Bay Area Community Medical Group
Dear Dr. Michael:
You may recall I was your patient from 2009-2010. During that time, you treated me for a trapezius muscle spasm, drug-resistant hypertension, and low potassium.
The last time I visited your office, I presented with heart palpitations and a racing pulse. Your assistant, Anita, noticed this and did an EKG, which indeed showed tachycardia. Even though I had been concerned enough to pay a visit to your office, you appeared unconcerned, told me it was “anxiety,” and dismissed it as being a typical problem for a woman my age.
I found this response to be both ageist and sexist, which angered me enough to take my business elsewhere. I sought recommendations for another primary care physician and chose Dr. Rob Kassan. Within mere minutes of hearing my medical history, Dr. Kassan asked if I had ever had my aldosterone level checked. I told him to the best of my knowledge I had not; in the copies of my labs I have from the time I was your patient there is no evidence that this was ever considered.
Dr. Kassan referred me to Dr. Earl Gordon, a nephrologist and hypertension specialist. Again, within a few minutes of hearing my history, Dr. Gordon asked if I had had my aldosterone levels checked. Again, I told him I had not.
Dr. Gordon took me off of the medications you had prescribed – Diovan 360mg and Cardizem 180mg – as they can interfere with the testing. Interestingly, within days of being off of antihypertensives, my blood pressure went down rather than up. Blood tests revealed the following: Potassium 2.9, aldosterone 42.3, renin .5. As I hope you know, this is indicative of primary aldosteronism rather than essential hypertension.
Dr. Gordon ordered a CT scan, which revealed I have a 1cm nodule in my left adrenal. I am currently undergoing further testing to confirm that this is the source of the excess aldosterone, but given my other symptoms, it is probable that it is. Other complaints that I mentioned during my time as your patient, including frequent headaches and that muscle spasm, are consistent with the condition.
During the time I was your patient, rather than get to the cause of my problems, only my symptoms were treated. For a year and a half, I took numerous expensive and unnecessary medications that you prescribed, none of which did anything to help, as they were designed to treat essential, rather than secondary, hypertension.
I am writing this in order to educate you to avoid something like this happening to another of your patients. Enclosed are two articles that cover some of the basics of primary aldosteronism. I realize this is an uncommon condition and that you may not ever encounter another case in your practice, but please take a moment to educate yourself so that you will know what to do the next time a patient presents with hypertension and low potassium.
The Wayward Bus