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.

DEAR DR. GOTT: Wow. After years of good advice, you really blew it today. In your article on water-softener salt, you mentioned 1 teaspoon of salt contains 230 milligrams of sodium. Boy, are you way off. According to my sources, 1 teaspoon is equal to 2,000 milligrams or more! As you know, this is a huge issue in our society, and I’m sure you will set this right as you always do. Sign me a loyal reader, CPR instructor and home-care nurse that frequently copies your articles for home-care patient teaching.

DEAR DR. GOTT: In a recent article, you wrote that 1 teaspoon of salt contains 230 milligrams of sodium. The salt that I purchase at Wal-Mart contains 590 milligrams of sodium in 1/4 teaspoon. Morton’s Lite Salt has 290 milligrams of sodium in 1/4 teaspoon. Could you please tell me what salt has only 230 milligrams per teaspoon? My husband is on Aldactone owing to cirrhosis, and we had to stop using the Morton Lite Salt because of the potassium content.

DEAR DR. GOTT: I hope that this was a misprint in today’s Ventura County Star. You said 1 teaspoon of salt had 230 milligrams of sodium. There are actually 590 milligrams of sodium in 1/4 teaspoon of salt. Also, you felt that water softeners were not a hazard to a low-salt diet. This is not the case in my community. My husband has Meniere’s disease, and when he stopped drinking softened tap water, his symptoms were greatly improved.

DEAR DR. GOTT: Your estimate of the amount of sodium (230 milligrams) in a teaspoon of salt is low by a factor of 10.

DEAR READERS: Whew, have I been caught! My original column should have stated 2,300 milligrams, as several of you pointed out, not 230. Somewhere along the way, a zero was dropped, and I owe everyone an apology for the misprint.

While many products and additives may state they are “low salt,” it is extremely important to read labels to ensure this element is not taken in excess. For example, a can of soup is commonly very high in sodium to begin with, and the can may contain 2-1/2 servings, which can be deceiving. In the matter of cirrhosis, kidney disease and congestive heart failure, sodium can lead to a serious buildup of excess fluid.

A healthful, nutritious diet is important for everyone, whether dealing with a medical condition or not. And the best resource is a personal physician who knows your full medical history and can advise accordingly.
While we all like to think we are perfect, I am the first to admit I do make mistakes (and typographical errors). I thank those readers who brought this issue to my attention. I’ll make every effort to do better. Stay tuned, but keep those corrections coming.

Readers who would like additional information on dietary supplements should send for my Health Report “Vitamins and Minerals.” Address your request to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Include a self-addressed stamped No. 10 envelope and a $2 check or money order, and 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.

Many of the residents have had to take pills for high blood pressure and were never on them before. Some of these people are over 70 years old. Many of our residents are in the early stages of dementia and Alzheimer’s. It is scary knowing that possibly the salt water in our water system could be causing these problems. A faucet in the basement of our building isn’t connected to the system, so residents go there for a supply. The complex owner says he checked with a doctor who says the amount of salt in the water would not be harmful to us. Do we have a chance of having a real problem here? Should the water be changed?

DEAR READER: Hard water causes a buildup of chemicals in household pipes, stains sinks, discolors laundry, and dries out skin following bathing. That said, the National Research Council has gone on record stating that drinking hard water does not pose health risks. While I don’t know what the condition of the water is in your area, obviously the owner of your complex determined that installing a water-softener system was the best way to go financially in the long run.

The amount of sodium added to any system depends on the hardness of the water, but treated water doesn’t appear to add any significant amount of salt to the diet. Generally speaking, an 8-ounce glass of treated water contains less than 13 milligrams of sodium. The average adult without a history of hypertension requires between 1,500 and 2,400 milligrams of sodium each day. With a history of high blood pressure, the recommended amount holds at 1,500 milligrams.

A more likely cause of excessive sodium comes from a person’s diet. One teaspoon of salt contains 230 milligrams of sodium. Adding to that many processed foods, cold cuts, canned goods and soups brings the potential for excessive salt consumption far above the recommended daily allowance.

There is an association between Alzheimer’s dementia and aluminum. Perhaps this is what some of your residents refer to. I cannot find any confirming reports of memory loss, Alzheimer’s or neuropathy caused by water-softening systems. A more likely consideration is that the residents of your establishment are aging and are developing diseases and disorders common to an advanced age. That said, it appears that by making a trip to the basement for drinking water, residents who fear potential side effects can bypass the problem. I would also recommend that residents request a sodium test be added to their next routine lab work when they visit their physicians. Providing they eat a healthful diet and do not cook with or add salt to their meals, this will be one surefire way to resolve one of the issues.

Because of the concerns you raise, I am sending you copies of my Health Reports “Hypertension” and “Alzheimer’s Disease.” Other readers who would like copies should send a self-addressed stamped No. 10 envelope and a $2 check or money order for each report to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title(s) 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.

DEAR READER:
“White coat” hypertension is a condition in which blood pressure (BP) rises to above normal just before and during a doctor’s appointment but returns to normal or below normal upon leaving the office.

This occurs because of the anxiety and stress related to seeing a doctor. It is not related to true hypertension which is consistently high BP readings. There are steps that can reduce these feelings, as well as ways to achieve more accurate readings.

Establishing readings while at the doctor’s as well as at home in a more relaxed atmosphere will provides a basis for proper diagnosis between true or “white coat” hypertension. If home readings are at or below normal, then certain measures can be taken.

For example, relaxation techniques, such as deep breathing, can be done in the waiting room before an appointment. Having your BP checked at the end of the visit rather than the beginning will also allow for time to relax and adjust to the situation. If these steps fail, it may be necessary to purchase a blood pressure cuff for home use so that levels can then be sent to the physician on a regular basis.

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.

Why do they insist or believe they are in very good health? What do they consider poor health? I am a 72-year-old male. I’ve had a couple of stents put in my heart. I’m on Plavix and blood pressure medication. I also have skin cancer and have had several lesions removed. I wear a hearing aid.

I can still walk and mow the lawn, do work around my house and ride a bicycle, but I don’t consider myself to be in good health, just lucky and in better health than all those people who write to you. Whom are they kidding?

DEAR READER:
So much of life is in a person’s attitude. To some of us, the glass will always be half empty. For others, it will always be half full.

Hopefully we go through life eating and exercising properly, watching our weight and health, and visiting a physician for routine medical matters. Problems arise when our bodies don’t work as perfectly as we would like. We may be under stress and develop high blood pressure readings. A cancerous lesion may be discovered during a routine physical examination and needs to be removed. We may have a family history of heart disease, diabetes, stroke, and a host of other issues over which we have no control.

What isn’t beyond our control, though, is the attitude with which we approach health matters. By maintaining a positive attitude, we can learn to deal with some pretty gruesome issues and be grateful the situation isn’t worse. There are few promises in this world. When it comes to health, no amount of money can buy a perfect body that functions without mishap. Were this the case, we would then attempt to barter with the powers that be for an additional five or ten years because we haven’t done all the things we set out to do. The bottom line is to make the most of life despite the glitches and snags along the way. That’s what builds character.

You admit to remaining active and being in better health than many of my readers, despite your medical issues. Well, you’re a reader and still going strong. Work on your outlook, you’ll have much more fun. And your friends and family might just enjoy you more, too.

Because you mention stent insertion and hypertension, I am sending you copies of my Health Reports “Coronary Artery Disease” and “Hypertension“. Other readers who would like copies should send a self-addressed, stamped number 10 envelope and $2 for each report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).