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.

He ordered an MRI and an MRA, which showed that I had suffered a stroke and also have fibromuscular dysplasia in my neck. Because he was unfamiliar with the dysplasia, he sent me to a neurologist, who doubted the diagnosis because fibromuscular dysplasia typically occurs in younger people. To confirm the diagnosis, he sent me for a CT angiography, which showed I did indeed have it in the right internal carotid artery.

I was told there was no definitive treatment and that it may progress rapidly or slowly, although he thought in my case it would be slow. I was also told that my particular case wasn’t considered severe because there was no bulging and there was otherwise good flow through the arteries. The neurologist passed his recommendations on to my regular physician for periodic follow-up to include Doppler studies and ultrasounds.
Can you tell me more about fibromuscular dysplasia? Could my Grave’s, the radioactive iodine or the Levoxyl have contributed to this? Thank you.

DEAR READER: Fibromuscular dysplasia (FMD) is a condition in which one or more arteries develop an abnormal cluster of cells within the artery wall. The cell cluster causes narrowing, which reduces blood flow and may lead to organ damage. It most commonly affects premenopausal women between the ages 14 and 50 but may also be found in young adult men and older women.

FMD typically affects the renal arteries that supply the kidneys but may also be found in arteries that lead to the arms, legs, abdomen or brain. About 25 percent of those with FMD will have more than one narrowed vessel and while there is no cure, there are effective treatments.

Symptoms vary depending on which arteries are affected. If the abdominal arteries are involved, you may experience unintended weight loss or pain after eating. If the renal arteries are affected, you may experience neck pain, blurred vision or temporary loss of vision, dizziness, high blood pressure, chronic headaches, tinnitus, chronic kidney failure or ischemic renal atrophy (tissue death). If the peripheral arteries (arms and legs) are affected, you may experience weakness, numbness, cold limbs, discomfort when moving the limbs or changes in skin color or appearance.

There is no known cause, but it is believed that several factors may play a role, including hormones, abnormally formed arteries and genetics.

Treatment depends on the severity and location of the FMD as well as a person’s overall health. Medication is typically recommended and include ace inhibitors, calcium channel blockers and beta blockers, which are all medications prescribed for high blood pressure.

Many people who are otherwise healthy often undergo surgical repair of the affected artery or arteries and are often advised to take medication following surgery as a precaution. The most frequently recommended procedure is percutaneous transluminal renal angioplasty (PTRA), which essentially uses a balloon catheter to expand the narrowed section(s) of artery. Stents are not typically required to keep the vessel open. The last option is surgical revascularization. This procedure is used when PTRA is not an option, such as when the arteries are severely narrowed. There are several variations of this surgery depending on the location of the affected artery and the amount of damage present.

Return to your general physician, and request a referral to a cardiovascular surgeon or specialist who is familiar with the treatment of FMD. Clearly, your neurologist was not familiar enough with the condition to offer you advice regarding treatment. You can also learn more about it by visiting the Fibromuscular Dysplasia Society of America (FMDSA) website at www.FMDSA.org or by writing FMDSA, 20325 Center Ridge Rd., Suite 620, Rocky River, OH 44116. The phone number is (888) 709-7089.

I did have a malignant tumor on my prostate in 1996. After both were removed and the tissue was tested, I did not have to undergo chemotherapy or radiation. My PSA was 0 for nine years, but it is now reading 1.08. I also had a slight stroke six months before I started having the night sweats. The part of the brain affected was two small spots above the forehead. There were no visible signs of even having a stroke when the event occurred.

I take the following meds: albuterol, Advair, allopurinol, doxycycline, levothyroxine, Diovan, warfarin and fexofenadine. All meds have been checked for possible reactions. I am a male, stand 5 feet, 6 inches tall, and weigh 192 pounds. Please help. I’m miserable.

DEAR READER: The thing that stands out in my mind is your prostate cancer. You say both were removed. I take this to mean the tumor and the prostate gland itself. However, the problem with this situation is that now your PSA level is going up, which means that there must be some prostate tissue still present. Your rising level could indicate that the cancer was not eradicated entirely and is now making itself known. Your urologist should be examining you thoroughly to check for any possibility that the cancer has returned.

My next thought would be your stroke. Your neurologist would be able to tell you if the damage to your brain could have resulted in your night sweats.

Other causes of night sweats include medication side effects, certain infections, changes in various hormone levels (such as testosterone, thyroid, etc.) and some neurological disorders.

You say that your medications have been checked, but I will review them briefly. Albuterol and Advair are most commonly used to treat asthma. Allopurinol is primarily used for gout and may cause abnormal sweating. Doxycycline is an antibiotic. Levothyroxine is a thyroid hormone-replacement drug used to treat hypothyroidism. Side effects from this drug are typically caused by therapeutic overdose and resemble hyperthyroidism, of which excessive sweating is a symptom. Diovan is used for the control of hypertension. Warfarin is an anticoagulant used in patients with certain clotting disorders, blood clots, heart attack, stroke and more. Fexofenadine is used to treat seasonal allergies and uncomplicated idiopathic hives.

Two of these medications specifically list sweating as a side effect, but there is a possibility that two or more of these could be interacting, causing unwanted effects. Sit down with your primary-care physician or an internist to discuss the situation, and review the results from your plethora of specialists. Perhaps the answer is simple but your specialists are missing it because they are not looking at you as a whole body.

To provide related information, I am sending you a copy of my Health Report “The Prostate Gland.” 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. An order form is also available for printing at my Web site, www.AskDrGottMD.com.

I have talked to several members of the medical community who say that this is primarily due to the medication, orthotricyclin. Manufacturers state that five percent of women taking it will develop a blood clot. To me this still means hundreds of thousands of women are at risk.

Please raise awareness about blood clots and birth control.

DEAR READER:
Consider it done.

For many years now, gynecologists and physicians have known about the risk of developing blood clots because of birth control pills. Any prudent physician will tell all potential users of the risks associated and it is then up to the patient to decide if the medication is worth it.

As for orthotricyclin being the main culprit I cannot comment because I am not a gynecologist and never prescribed birth control pills. However, to the best of my knowledge, all hormonal forms of contraceptives carry the risk of stroke due to blood clot formation.

To give you related information, I am sending you a copy of my Health Report “Contraception”. 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 niece supposedly had a stroke. She then had X-rays that showed she had a small spot of bleeding in her brain. She went to several doctors because she had all kinds of things happening to her like headaches that nothing helped that disappeared, only to be replaced by seizures. She was having trouble walking and her memory was getting worse. Her legs would give out and she would fall. One arm became limp and a host of other things.

All this lasted for two years and was accompanied by numerous hospitalizations. Finally her doctor told her that both carotid arteries were plugged. He said it was caused by plaque. She kept getting worse so her husband changed her doctor and switched hospitals.

The new physician, after seeing her, referred to a teaching hospital. She had a couple of tests and more X-rays. She was told she didn’t have plaque buildup in her carotid arteries, but rather infection, and was then diagnosed with vasculitis.

I am told it is a very rare blood infection. She is now taking large doses of prednisone and her physician says she will likely get most of her memory back. She is getting better already and can now walk by herself again (but still has someone with her at all times, just in case). She has also regained use of her arm.

My reason for writing is that I don’t understand why her new doctor hasn’t let the whole world know about this new disease he has found. He said he has been a doctor for more than 30 years but has only ever seen one other case of vasculitis. When I talked to my personal physician about it, he said he had never even heard of it.

DEAR READER:
Vasculitis is inflammation (not infection) of the blood vessels, capillaries, veins and/or arteries. When this occurs it can weaken and narrow the vessels which may result in blockage. With decreased blood flow, less oxygen can be supplied to muscles and other tissues. If the inflammation is not brought under control, tissue, muscle and organ damage may occur. If the damage is severe, it may result in death.

There are several disorders that fall into the vasculitis family and include Churg-Strauss Syndrome, Kawasaki disease, Wegener’s granulomatosis, polymyalgia rheumatica and more.

While each disorder is different, many of the symptoms overlap. The primary distinguishing point is the type of blood vessels that are affected (small, medium or large). General symptoms include shortness of breath/cough, joint pain, asthma, fever, rash, fatigue/weakness, abdominal pain, visual changes and more.

Vasculitis can affect anyone at anytime but certain forms affect specific age groups more than others. It is considered to be an autoimmune disorder, meaning that the body attacks itself.

There is no known cure, but with early diagnosis and treatment, most sufferers can lead relatively normal lives. Treatment can include steroids (prednisone and others), immunosuppressive medications and antibiotics.

I suggest you and your daughter return to her physician to discuss her condition. Vasculitis by itself is not a diagnosis, it is simply a broad term to identify a primary symptom. If you are one of her care-givers, it is also vital that you understand what the condition is, what type of treatment she is on and what warning signs to look for if she has a relapse.

To give you related information, I am sending you a copy of my Health Report “Stroke”. 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:
The soap-under-the-sheets remedy was originally sent to me as a cure for night-time leg cramps but since then many RLS sufferers have also found relief using it. It does not work for everyone but it is worth a shot. Simply place a bar of soap under the bottom sheet of your bed near your legs. That is it. Many individuals have also found that if they have a problem while not in bed, putting soap in their socks or rubbing liquid soap directly onto their legs also reduces pain. Let me know if it works.

As an aside, I recently received a product in the mail called Wilcox Family Products Leg Cramp Relief. The manufacturer claims that after seeing first hand the benefits of soap-under-the-sheets, he wanted to know how it worked. He interviewed soap manufacturers and formulation specialists from across the country. He then began working with a specialized chemist (40 years experience in soap, cream and lotion). Together they isolated and concentrated the common soap ingredients found in the most beneficial brands.

Anyone interested in finding out more about the product or purchasing it should go online to www.WilcoxFamilyProducts.com. I will also say that I have no financial, personal or business interest in the company and was not paid in any way to promote it. I am simply mentioning it because I believe it may be of great interest and benefit to my readers.

To give you related information, I am sending you copies of my Health Reports “Dr. Gott’s Compelling Home Remedies” and “Stroke”. Other readers who would like copies should send a self-addressed, stamped number 10 envelope and $2 (per report) to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).

My uncle was 89 and my aunt was 85. They were married 65 years on Valentine’s Day 2007 for which we had a surprise drop in party. They loved it. We had as many family and friends there as possible so they could talk and reminisce with them. It was a very enjoyable time for them to say the least. They talked about it for a long time afterwards.

They have been an inseparable couple throughout their whole lives, working side by side on the farm with no outside help, seven days a week, 365 days a year. They never wanted to be apart from each other. They had a devotion for each other that went beyond words. Both displayed anxiety when the other was not by their side.

These same people were in a nursing home for over 2 years in the same room by their request. Their care was the highest level of nursing care due to my uncle’s needs. He had multiple strokes many years ago, was blind, on a wheel chair and had to be nurse-fed with pureed foods. He also was diagnosed with terminal cancer and placed under hospice care. He continued to remain in the same room with his wife. My aunt said that she was glad he made the decision to stay with her through all of this.

My aunt always prided herself in taking care of her husband, even in the nursing home. Shortly after entering the home she was diagnosed with Alzheimer’s, had trouble walking and then had a major stroke. She was placed under hospice care shortly after my uncle was.

I choose to keep them both together in the same nursing home room, rather than sending her to the hospital because I felt it was the best for them both. The nursing staff moved the beds closer together so my uncle could talk to her and hold her hand. She would on occasion respond to is voice. My uncle told me that he had held his wife’s hand more in the nursing home than he had in 65 years of marriage. The nursing staff even said that to see them holding hands was very sweet and endearing. I never regretted keeping them together.

My aunt, before her stroke, always talked about death in a matter of a fact way and saying that one of them would have to die first and she hoped it would be she. After the stroke, several family members started stating their opinions such as “Why isn’t she in the hospital?” or “Did she have that shot?”. These well intentioned people did not know about her true medical condition that the doctor and nurses shared with me nor did they have knowledge of her living will. These same people were never close enough to see or hear what her true wants and wishes were, either. I based my care-taking decisions on the facts from the medical staff, her living will and wishes and consultation from a minister.

What little time my aunt and uncle had left needed togetherness, as they would have wanted it. The staff and I kept hoping that at some point she would be lucid enough to speak to her husband, since he was blind and couldn’t see her. It was something he wanted very badly, to hear his wife’s voice, just one more time. No one thought it would be possible, but our prayers were answered. Just before her passing, my aunt spoke to him and said “I will love you forever and ever, till death do us part and beyond”. Five weeks later, my uncle passed away after telling the nursing staff that he was going home soon to be with his wife and son.

The time they shared at the end was priceless. No amount of additional medical care could have taken the place of their love and time together prior to their earthly parting.

DEAR READER:
Thank you for sharing this inspiring story. This is perhaps one of the best cases of a loved one and medical staff working together to fulfill two patients’ wishes. They seem to have had a love beyond words and I believe that you did everything you could to ensure that they were happy and comfortable to the end.

I am printing your letter in its entirety to show others that, even in this day and age, kindness, compassion and love can prevail. I hope families faced with these hard decisions and medical personnel can draw from your experience and put it into action to make others as happy as your aunt and uncle were at the end.

During his recovery, I noticed he would make moaning sounds in his sleep and when anyone would ask him if he had slept well, he often said he didn’t know or that he must have because he was in bed for 12 hours.

Most of the information I read about strokes included what he was most likely going through (emotional ups and downs and personality changes are common). I knew that this was something the family had to get through but it was hard because every now and then he would have some very normal days. I started to pick up on some clues that led me to believe he might be sleep deprived. He was and still is very driven in his recovery. I think sometimes he spent the time he should be asleep going over things in his mind and exercising in an effort to get better.

I decided to try a sound machine to help him sleep. I purchased a sound spa from HoMedics that places nature sounds, such as the ocean, rainforest, thunder, waterfalls and so forth. It also projects the time on the ceiling so that you don’t have to search for the clock to know what time it is.

I told my dad to give it a try and to try to focus on the sound and let his mind rest. The next morning he woke up and said it was the most rested he had felt in a long time. That afternoon when I got home from work he was asleep on the couch and the moaning sounds were gone. In fact, a few days later he was back to his old snore!

I believe the sound spa has helped a great deal in his recovery. I don’t know if sleep deprivation is addressed in stroke recovery but I believe it should be. I wonder if, as it seems to be in my dad’s case, the change of personality that some stroke victims have could be attributed to sleep deprivation. I would urge anyone who is caring for a stroke victim to give it a try. Even if it doesn’t work for the patient, it might be helpful for the caregiver and at under $30 it is well worth a try.

DEAR READER:
I believe sleep deprivation may be more common in stroke victims than previously thought. The product you found and recommended to your father appears to have had great results so I am passing the information on to my other readers. Regardless of the cause of the sleep deprivation this machine may be of benefit by playing relaxing natural sounds that can gently sooth the mind allowing for sleep to come more easily.

To give you related information, I am sending you a copy of my Health Report “Stroke”. 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.

He has survived Hodgkin’s Lymphoma (1988), a 5 way by-pass surgery (1991), stroke (1997), and two carotid artery surgeries (1997 and 1998). He has type two diabetes as a result of his lymphoma chemotherapy. He is in kidney failure, was diagnosed with bladder cancer in 2005 and myelodysplasia.
He regularly sees an oncologist, endocrinologist, nephrologist, urologist and cardiologist. His medications include pain relievers, blood thinners, cholesterol reducers, calcium, vitamins, water pills, and many more.

I would like your opinion. We have insurance which I am very thankful for. I respect his doctors and their opinions as I do yours. I am worried, though, that he is over medicated. I also am worried that if he stops any of these, it would be his end. He leads a fairly normal life other than sleeping a lot, but given the situation, I would expect this. He does not do much, cannot play golf and is no longer sexually active (even though he would like to be). It is just not possible for him to do the things he wants and enjoys the way he used to.

DEAR READER:
Your husband has several serious medical ailments for which he is taking various (and mostly appropriate) medications. In your list, I do see two medications that I believe could be safely stopped. Valtrex is given to individuals with genital herpes as an outbreak preventive or treatment. Because your husband is not sexually active, there is little risk of him passing this condition on to you. You also state that your husband sleeps a lot. I note that he is taking Lunesta which is a sleep aid. If he is getting more than adequate sleep (7-8 hours) I don’t believe he needs this. If he is taking it because he cannot fall asleep at night, perhaps this is a result of him sleeping too much during the day. Try to keep your husband as active as possible during the day and he should have no problem sleeping at night.

Before making any modifications, I suggest you discuss your concerns with his physicians. Perhaps they would be willing to set up a conference call or meeting at which you and your husband can discuss the necessity of his medications and whether or not any can be modified, reduced or stopped. It is important, given his various ailments, that all his physicians agree on medication modifications. Perhaps now is also the time to involve a primary care physician who can help you sort out his medications and treatments. This will also help in the future if his situation becomes worse. At that time he may wish only to have medication to make him comfortable. Your husband’s quality of life should be of the utmost importance and if he is not enjoying his life and is missing out on the things he loves, his is, in my opinion, suffering. This can also lead to depression.

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