Splitting up blood pressure med could help stabilize levels

Dear Dr. Roach: I’m a 73-year-old active male whose health is generally good. I’ve been taking 40 mg of lisinopril nightly for six years. Over the first few years, it produced good results over the course of 24 hours.

Now it seems that my blood pressure is a bit low in the morning and more normal later in the day. In the morning, it hovers around 95/52 mm Hg even after I go for a jog, and in the late afternoon, it’s about 130/60 mm Hg. I do feel a bit fatigued in the morning. I have pretty bad “white coat syndrome,” which also affects a 24-hour blood pressure monitor.

I wondered about asking my doctor whether it might be advisable to change to 20 mg twice a day. I’m hesitant to add a diuretic, as I have chronic low sodium levels. What do you think?

J.W.

Answer: Lisinopril generally works pretty well when taken just once a day, but the difference between your morning numbers and afternoon numbers is so great that taking the same amount of medicine (40 mg) broken up into 20 mg twice daily makes sense to me. I would also ask you to be conscious about other factors that can raise your blood pressure, like salt and alcohol intake.

I don’t recommend increasing medicine at this time (like a diuretic), not only because of the low sodium issue – diuretics are notorious for making that worse – but also because I’d be concerned that the morning numbers could get lower, worsening your morning fatigue.

Dear Dr. Roach: A loved one told me that she’s going to start taking colloidal silver to help fight her cancer. Would you please share what you know about it? B.I.

Answer: Friends shouldn’t let friends take unproven medications. Colloidal silver has no known benefit and cannot be excreted by the body. In rare cases, silver poisoning (argyria) can ensue. I understand that a person with cancer is sometimes willing to look beyond standard medical treatments, but colloidal silver is dangerous and has no known benefits.

There are many alternative medications that can help make people feel better as they battle cancer. The side effects of cancer treatments – chemotherapy, radiation, surgery – can be severe. Valid alternative treatments include mindbody medicine, massage, exercise and acupuncture. I’d much rather see her invest her time in one of these.

Dear Dr. Roach: About 20 years ago, I had my ears cleaned by a doctor’s aide. She used a water pump and got about a teaspoon of wax out of each ear. I could hear a lot better. Now I can’t find anywhere that they will clean my ears with a pump. They all recommend a little squirt bottle that does almost nothing. J.H.

Answer: If your regular doctor says you have ear wax, and they can’t get it out, see an ear, nose and throat doctor who has the correct tools to diagnose and treat the problem. Using warm water to flush out the ear wax is effective for those who know how to do it properly, but there are other treatments that are just as effective and may be less intrusive.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Drive, Orlando, FL 32803.