DEAR READER: There are a number of causes for dizziness, including vertigo, benign paroxysmal positional vertigo, Meniere’s disease, inflammation of the inner ear, migraine headaches and as a result of using specific medications. Dizziness can also result from specific medications, low-blood-pressure readings (hypotension), Parkinson’s and other neurological disorders, nerve damage to the legs, inner-ear abnormalities and anxiety.

Your first step is to work with your physician to determine the cause of your hypertension. If there is an underlying condition such as an inappropriate diet, excessive salt consumption, obesity or lack of exercise, take steps to bring the matter under control.

Both medications you have been prescribed treat hypertension. Diovan carries such side effects as headache, diarrhea, back/joint/stomach pain and dizziness. Tekturna does not carry a side effect of dizziness.

You didn’t indicate what your blood-pressure readings were prior to being placed on medication. While I don’t know the specific numbers your physician is hoping to achieve, you might consider asking if you can reduce the dosage of your Tekturna. While it doesn’t come in doses smaller than 150 milligrams, perhaps you can take half-doses, if appropriate.

To provide related information, I am sending you a copy of my Health Report “Hypertension.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

My physician put me on lisinopril/HCTZ and a few months later added metoprolol XL. He later added amlodipine. Each was one tablet daily.

I began to have hot flashes and then felt cold. My stomach was upset, and I was very tired. So I started skipping the medicines and take none of them now. I walk a lot and feel much better. I realize high blood pressure is dangerous, but what about side effects, if that’s why I felt so bad? My blood pressure is about 160/75. I have a home blood-pressure cuff to monitor things.

What is your opinion of trying to control my own blood pressure without the meds?

DEAR READER: Unfortunately, you failed to include your blood-pressure readings while you were on one, then two, then three medications. That information would certainly tell the story and would give me my answer.

To begin with, your lisinopril/HCTZ is an ACE (angiotensin-converting enzyme) inhibitor that helps lower your blood pressure and acts as a diuretic. The diuretic prevents the body from absorbing too much salt, which can lead to fluid retention.

The metoprolol XL treats hypertension and also acts as a long-term treatment for angina and stable heart failure of cardiomyopathic, ischemic or hypertensive origin.

The amlodipine is a calcium channel blocker that dilates blood vessels, lowers your heart rate, and increases the flow of blood to the heart. It is prescribed for hypertension, angina and high-cholesterol levels.

I cannot determine if your physician has found the right combination for lowering your blood pressure by combining all three or if there may be other underlying conditions requiring treatment. Were I in your shoes, I would speak with my physician for an answer and be guided accordingly. If the only issue is hypertension and you have substantially reduced your readings without the help of medication, I endorse the plan. Exercise, a healthful diet and stress reduction perhaps through water aerobics, massage, yoga or tai chi can go a long way toward that goal and you appear to be well on your way to a healthier existence.

To provide related information, I am sending you a copy of my Health Report “Hypertension.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

I formerly was walking two miles a day; now I can barely walk a half-mile, and that is with stops. I have tried niacin and red yeast rice. I am currently taking omega-3 and flaxseed-oil capsules.

I am 5 feet, 2 inches and weigh 168 pounds. I am careful about my diet. I feel good and energetic when not taking a statin; however, I’m lethargic when taking the drug. I’m afraid to quit but am truly miserable, so which is the lesser evil? I truly do not know what to do.

DEAR READER: Statin drugs work well, but for some people, the price is high. This poses the question of whether the benefits outweigh the risks. No one wants to suffer a heart attack or stroke, nor do they want unpleasant side effects such as those you have experienced. The answer should be a decision between a patient and his or her physician. That said, there might be alternatives. First, however, let’s hit some possibilities.

You can lower the dose of your medication. This may reduce or eliminate the leg cramps and fatigue but may also reduce the effectiveness of the statin. You can change to another label; however, this might not be successful. You have already cut back on your exercise routine, so I can’t endorse a further reduction. While some researchers question its effectiveness, you might consider ezetimibe, a prescription cholesterol-absorption inhibitor, or you might try an over-the-counter with natural plant stanols and sterols. You don’t indicate if the niacin was at all effective. Did you give it a try for a satisfactory length of time?

If you smoke, discontinue the habit. Eliminate fried foods, the skin on chicken and the fat on steak. Broil meats, and be sure to cut off any excess fat prior to cooking. Continue to exercise and modify your diet. Eat more fruits, vegetables, whole grains, fish and chicken. Limit the amount of cheese and eggs you consume, and switch to fat-free milk.

Ask your physician if he or she would consider an appropriate length of time so you can initiate a new diet and exercise plan. Perhaps a referral to a nutritionist and the physical-therapy department of your local hospital will be appropriate. Consider an OTC that doesn’t contain a statin component.

Ask your physician or specialist for advice on treating your leg cramps. If an underlying cause, such as iron deficiency or peripheral neuropathy, enters the equation, obtain appropriate treatment. Then consider ibuprofen, meditation, yoga and warm or cold packs. Avoid caffeine and alcohol. Place a bar of soap under your bed sheet to alleviate cramping. Exercise, but don’t overdo it, because fatigue will make your symptoms worse.

To provide related information, I am sending you a copy of my Health Report “Understanding Cholesterol.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

After my last infection, a biopsy was done. The report said: “Vulvar Biopsy: Ulceration with very severe active chronic inflammation and numerous plasma cells. A serology for spirochetes was negative.” The microscopic description said: “The skin surface is covered by squamous epithelium which is moderately to extensively eroded. There are superficially dilated capillaries and there is a dense infiltration of lymphocytes and plasma cells in the upper dermis. Warthin-Starry stain is negative with appropriately reacting controls. Immunostain for AE1/AE3 is negative for epithelial component. Positive and negative controls worked as expected.”

My concern is that the Premarin cream is now making my ankles swell, and my blood pressure has gone up. (It is usually normal.) Also, when I call my OB/Gyn, I am no longer asked to come; they simply call in a prescription. I am never told to return for a follow-up and feel that this is because I am on Medicare. So far, this has happened with three separate gynecologists.

Do you have any advice or help to offer me?

DEAR READER: Let’s start with the biopsy report. First, ulceration is easy to understand. This simply means that you have a sore. Whether it was caused by scratching or something else is unclear. Inflammation means swelling. Again, this could be caused by scratching or the infection itself.

The identification of numerous plasma cells is more telling. These cells are a type of short-lived antibody-producing leukocyte (a type of white blood cell) that binds with a foreign substance (or what the body perceives to be a foreign substance) and then begins to neutralize or destroy it. Lymphocytes are another type of leukocyte and determine the specificity of the immune reaction to foreign substances and infectious agents.

All of this indicates that your body is fighting off an infection of some sort, is incorrectly attacking normal cells, or is overreacting to a substance you have come into contact with, such as perfumed feminine-hygiene products.

Now, on to what is causing your so-called yeast infection. First, you do not say what symptoms you are experiencing, so I will first review them. These can range from mild to severe and include redness and swelling of the vulva; itching, irritation, pain and/or soreness of the vulva and vagina; a thick, white, odor-free vaginal discharge similar in appearance to cottage cheese; and a burning sensation.

Yeasts are typically present within a normal vagina and in most instances do not present problems. For several reasons, yeasts can multiply and cause symptoms of an infection. In most cases, Candida albicans is the culprit. Thankfully, this type of yeast can be treated easily.

People who have never had a yeast infection before, have more than four a year, or fail to improve with treatment may require extensive testing, including cultures of any discharge or vaginal secretions. Long-term or multidose oral medications and maintenance regimens may be appropriate.

If you truly have a yeast infection, it is either not being treated properly and eradicated completely or it is the result of an underlying condition, such as long-term antibiotic use, uncontrolled diabetes or something else. Return to your gynecologist and demand answers or get a fourth opinion.

I recently came across an article on the topic of isolated systolic hypertension, in which a physician pointed out that this form of hypertension can lead to serious problems — stroke, heart disease, chronic kidney disease and dementia. The doctors and nurses who have taken my blood pressure have universally said that the diastolic reading was not a consideration; however, this report indicated that medications to control systolic hypertension should not be allowed to cause the diastolic pressure to go below 70 mmHg.

I am an 82-year-old diabetic male off medications for three years now due to exercise and diet. I also have symptom-free bradycardia. I would very much appreciate your comments on this report.

DEAR READER: I am a little confused. You indicate you are a diabetic and have hypertension that was treated with two medications. You then go on to state that you have been off medications for three years. Does this mean the antihypertensives, diabetes meds or both? In any case, I congratulate you on taking control and maintaining a healthier lifestyle.

Isolated systolic hypertension is defined as a systolic reading of greater than 140 and a diastolic reading of less than 90. The condition can result from hyperthyroidism, a leaky heart valve or other causes.

There was a time when doctors devoted their attention to the second number, the diastolic, with the thought the body could tolerate fluctuations in the first reading. Then there was the “blanket rule” that the first reading would be normal at 100 plus the age of the patient, i.e., 175 in a 75-year-old male. Both schools of thought have been modified. Today, the systolic and diastolic are of equal importance, and the 100-plus reading has been totally abandoned.

Of concern in patients with isolated systolic hypertension is that prescribed medications may affect the second number, lowering it to the point that it might increase the risk of heart attack or stroke. The fine line then becomes keeping the diastolic at no less than 70 mmHg, while simultaneously keeping the systolic at an appropriate figure, just as the report indicated.

My guess is that your diastolic readings are too low, and that you might require medication to bring both numbers into line. Take a copy of the article to your physician for his or her review. A determination can then be made about whether you should be back on the two medications or not. No matter what, I would continue the exercise and diet modification.

The lisinopril you are/were taking is an ACE inhibitor used to treat hypertension and congestive heart failure. It can be used alone or in conjunction with other drugs for the same purpose. The amlodipine is a calcium channel blocker that works to lower blood pressure and decrease the heart rate. It, too, can be used in conjunction with other drugs for best results.

To provide related information, I am sending you a copy of my Health Report “Hypertension.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

DEAR READER: Ameal consists of two bioactive tripeptides — valyl prolyl proline (VPP) and isoleucyl prolyl proline (IPP) — that are extracted from milk proteins. The product is purported to block biochemical reactions in the body that can cause blood vessels to narrow and result in rising hypertension. It should be used in conjunction with proper diet and regular exercise.

While you ask about maintaining readings within the normal range, you don’t indicate whether you have been diagnosed as pre-hypertensive or whether you clearly have hypertension. You also don’t specify other pertinent facts such as your age, gender, race and family history.

Blood pressure tends to increase as we age. This is likely because the arteries and arterioles become less elastic, preventing them from working as efficiently as they did before.

Hypertension is more common in men than in women between the ages of 35 and 50. At the age of 55, the rates are relatively equal. By 65, the rates for women surpass those of men.

African-Americans are twice as likely to develop hypertension as are Caucasians, and the condition is generally more severe.

Last but not least, hypertension runs in families. People with a family history of heart attack or stroke at a young age run an increased risk of developing hypertension.

Blood pressure is the force exerted by the blood against arterial walls as it is pumped from the heart throughout the body. A normal reading is 120/80 millimeters of mercury. High blood pressure occurs when readings become elevated beyond the figures quoted.

Were I to provide guidelines, I would prefer you exercise regardless of your weight. If appropriate, begin a weight-loss program, discontinue smoking, eliminate salt from your diet, and reduce or discontinue any alcohol consumption. These steps should keep your blood pressure in check without the use of supplements.

Work with your physician to determine whether you truly have high blood pressure, and get his or her views on other ways of bringing your levels down. Request a trial of my suggestions, if appropriate, as well as the other recommendations presented to you at your meeting. Following that, if prescription medication is necessary, you can be guided accordingly.

To provide related information, I am sending you a copy of my Health Report “Hypertension.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

I read in a book that this medication can cause liver damage but my doctor does not want me to change to a different drug. He says I have an irregular heart beat and this drug is best for my condition. I recently had a CT scan done and he says everything looks normal.

Is there something else you would recommend that would be safer to take and still be suitable for me?

DEAR READER:
Cardizem (diltiazem) is a calcium channel blocker used to treat hypertension and certain other cardiac disorders. It has also been shown to increase exercise tolerance for individuals with angina (heart pain).

As is the case with many drugs given over prolonged periods, it is recommended that kidney and liver functions be monitored at regular intervals. This can be done through simple blood testing. If you have elevated readings, your physician can either reduce your dosage, eliminate the drug altogether, or switch you to another medication. Keep in mind that all drugs have side effects, and you might be trading one set of problems for another. Therefore, if your liver chemistries are normal, I recommend you stick with the diltiazem and undergo periodic blood testing.

Your physician knows you best. It appears he is on the right track and is treating you appropriately.

If you have any ideas that will help her, it would be greatly appreciated.

By the way, your article on grape seed extract helped her cure her Parkinson’s immediately. She had it over 5 years. Thank you very much.

DEAR READER:
Most headaches are minor and can be treated with over-the-counter pain relievers, while others can signal a serious medical problem. It certainly appears your wife falls in to the latter category.

Digitek is generally prescribed for cardiac-related conditions such as atrial fibrillation and heart failure but can also be used for impaired kidney function, electrolyte and thyroid disorders, and more. This product can cause visual disturbances, headache and several other problems. Amlodipine (Lotrel) is used to treat hypertension. A noted side effect is headache. HCTZ, also used for control of hypertension, can produce headaches as a side effect.

It would be my guess her physician is attempting to treat several conditions with several medications and there is a reaction occurring between them with headaches being the unwanted result. She could simply be over-medicated.

I urge her to return to her primary care physician or the specialist that ordered the drugs initially. As long as her medical conditions are under control, he or she may wish to experiment by reducing one medication at a time. If the headaches disappear, she will have her answer. If not, a specialist such as a neurologist might be consulted. Perhaps she can become involved with a headache clinic that can provide answers and relief. I’m sure she is frustrated, but I urge her to follow through until the answer can be found.

To give you related information, I am sending you a copy of my Health Report “Hypertension”. Other readers who would like a copy should send a self-addressed, stamped, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

DEAR READER:
Thanks for the great tip. A spoon full of applesauce or hot cereal can often accomplish the same thing, but I’m passing your suggestion on to readers who might share the same problem.

To give you related information, I am sending you a copy of my Health Report “Hypertension”. Other readers who would like a copy should send a self-addressed, stamped, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

My over-the-counter drugs are a one-a-day multi-vitamin, calcium 1000 mg plus D daily, and calcium citrate 315 mg with 200 IU of vitamin D.

Years ago I noticed hair loss and attributed it to the metoprolol. The problem keeps increasing and, in fact, if it continues, I will need a wig in another year. I mentioned the problem to my doctor and her reply was that all medicines make people lose hair. Would I be wrong in asking my doctor to take me off the metoprolol and prescribe another medication for my high blood pressure? I showed her the drug information provided by my pharmacy indicating hair loss as a side effect.

I recently changed primary care physicians since my first doctor wasn’t concerned at all about my hair loss. What can I do?

DEAR READER:
Let me begin with some general information. Medications must go through several clinical studies before being approved. This is done by giving thousands of people a drug, while others are given a placebo. During the studies, no participant knows if he or she is taking the real thing or a placebo. An adverse consequence in more than 1% of the people studied in both categories is referred to as a common side effect, while less than that amount is referred to as rare. Once a drug is approved, it is no longer studied.

Now for the bad news. You are on lisinopril, metoprolol and prednisone. Rare side effects of all three drugs list hair loss as a possibility. Steroids are known to precipitate hair loss in men, yet all women have some male hormones. Therefore, of the prescription medications you take, all three share a similar consequence. The good news, according to my resources, is that the hair loss is generally reversible once a drug is discontinued.

It could be difficult in your situation to determine which drug might be causing your hair loss, unless you kept meticulous records indicating when the pattern began. As we age, we suffer wrinkles, heart problems, hypertension, arthritis and more. It’s difficult enough dealing with the problems over which we have little control. We shouldn’t have to deal with balding when it might be preventable. I recommend you speak with your new primary care physician who might be able to prescribe different medications in each instance without such an emotionally devastating side effect, no matter how rare it might be.

To give you related information, I am sending you a copy of my Health Report “Consumer Tips on Medicines”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.