DEAR DR. DONOHUE: In March I saw a cardiologist. His nurse took my blood pressure, and it was fine. Thirty minutes later the doctor waltzed in, took my pressure, reported I had high blood pressure and gave me a prescription costing $200 a month. I borrowed a new heart monitor and took my pressure 45 times in the next three days. No high blood pressure. I read a book from the library that said, “A diagnosis of high blood pressure cannot be made with only one reading.” Why has this cardiologist given me a diagnosis and a costly prescription with only one reading? – A.K.

ANSWER: There is an official rule book that specifies how blood pressure is to be taken. The rules are as follows:

The blood pressure cuff must be the right size. A too-small cuff gives erroneously high readings; a too-large cuff underestimates blood pressure.

For a valid reading, the patient should be seated comfortably for five minutes before the pressure is taken.

Patients should not have smoked or drunk any beverage with caffeine in the 30 minutes prior to having the pressure checked.

The patient’s arm should be at heart level and supported either by the doctor or by resting it on an adjacent table.

Two readings are suggested, with at least two minutes between readings.

Unless the pressure is dangerously high, a repeat blood pressure one or two weeks after the initial exam should be scheduled.

Often, time constraints make adherence to these rules impossible, but in questionable cases the rules ought to be observed. Why not get a second opinion from a less-rushed doctor?

DEAR DR. DONOHUE: I am a 73-year-old widow who was quite healthy until two years ago. Now my problem is breathing. I have seen a pulmonary specialist for two years. I have to use oxygen at night because my oxygen drops too low. I expel a great deal of thick, cream-colored mucus. I am not getting any better.

My son saw a program on nontubercular mycobacteria and thinks this might be my problem. What are your thoughts? – B.H.

ANSWER: “Mycobacterium” (MIKE-oh-back-TIER-ee-um) is the family name for a large group of diverse bacteria that can produce diverse illnesses. Sometimes they produce no illness. And often, when they do cause illness, they cause it in people whose immune systems are not up-to-snuff. One mycobacterium causes tuberculosis. The other members of the family are, therefore, called nontubercular mycobacteria.

The program your son saw was one dealing with mycobacterium avium complex (MAC). This bacterium can cause lung infections similar to TB, but most often it is a harmless freeloader that vacations in people’s lungs without creating a fuss.

Doctors diagnose true MAC infection with a chest X-ray or a lung scan that shows tiny lung cavities and with a culture of the sputum that proves this germ is in your lungs. Mention your son’s information to your doctor, and the possibility of such an infection can be confirmed or dismissed based on the results of the above tests.

DEAR DR. DONOHUE: I have been told there are natural and synthetic vitamins. What are the advantages or disadvantages of one over the other? – M.T.

ANSWER: Natural vitamins are vitamins extracted from foods. Synthetic vitamins are made in laboratories. People often jump on the natural bandwagon because they feel anything that comes from Mother Nature must be superior.

There are no advantages that natural vitamins have over synthetic vitamins and vice versa. Cost should be the determining factor in making a choice.

One exception to the above is vitamin E. Natural vitamin E is better absorbed than man-made vitamin E.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.

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