DEAR DR. DONOHUE: High blood pressure is my problem, and I don’t know what to do about it. I take Cardizem LA, 360 mg, and hydrochlorothiazide. I got very scared when my doctor put me on this high dose of Cardizem. During the day, my pressure is down, but when I wake up it’s high. I walk every day, watch what I eat and have lost 20 pounds. Why is my pressure so high when I wake? I am a basket case. – O.C.

ANSWER: Blood pressure fluctuates throughout the day and night. It’s at its lowest during sleep, and it spikes to its highest upon wakening. You might be taking your pressure too soon after you wake. A transient spike in blood pressure isn’t going to create terrible consequences. The pressures during the day – which also vary, but not as much as the early-morning surge – are more important for health.

Wait an hour after wakening before taking your pressure. Don’t drink anything with caffeine in it, and don’t smoke for 30 minutes before recording your pressure. Be seated comfortably in a chair for five minutes before you inflate the cuff, and have the cuffed arm supported and approximately at heart level. You can sit on a kitchen chair, if it’s comfortable, and rest your arm on the kitchen table, if it’s high enough. Take one reading, then wait five minutes and take another. Use the lower reading as your true blood pressure.

If this is too much bother, ask your doctor to make arrangements for a 24-hour ambulatory blood pressure recording. The blood pressure cuff stays on your arm all day and night, and the apparatus records your pressure every 15 to 20 minutes. With such information, you and your doctor can see if your morning spike is an irrelevant, short-lived event.

Your medicine dose is not so high. Do you know what “LA” stands for? Long-acting. You are taking only one long-acting pill a day instead of having to taking multiple doses. In one pill, you have the equivalent of many pills.

For most people, taking blood pressure twice a week is enough. You might be driving your pressure high by fretting about it too much.

DEAR DR. DONOHUE: I have whiteheads on my face. What can be done to get rid of them? – M.D.

ANSWER: Whiteheads and blackheads are two manifestations of the same process. They are skin pores clogged with impacted skin oil. If the opening of the skin pore is sealed off from air, the result is a whitehead. Air in contact with oil turns it black. An opened, clogged pore, therefore, is a blackhead.

Both can be the first stage of a pimple. If the pore becomes inflamed, then a pimple results.

The same medicines used for acne often work for whiteheads and blackheads. You’ll find them on the shelves of all drugstores. Choose ones that have either salicylic acid or benzoyl peroxide. Be patient. It takes months before you see results.

DEAR DR. DONOHUE: What are prions that affect the brain? Are they incurable? Is there an epidemic of them? – J.M.

ANSWER: Prions were discovered in 1982, but they have been in existence for eons. We are not facing a new enemy.

They are unique among infectious agents, since they are proteins without any nucleic acid, the stuff we thought all life forms must have.

Prion illnesses are few, and most human prion disease is confined to the central nervous system – the brain. Creutzfeldt-Jakob disease is one example. It’s been known about for many, many years, but the prion association is a recent bit of information about it.

DEAR DR. DONOHUE: My wife had pneumonia. She had diabetes, high blood pressure and sarcoidosis. She had been feeling bad, and the doctor discovered she had pneumonia and put her in the hospital. She died in the hospital, and I was informed she had ARDS. I’d never heard of that. It distresses me that we weren’t aware of her problem and didn’t do anything to help her. – R.H.

ANSWER: ARDS is acute respiratory distress syndrome, formerly called adult respiratory distress syndrome. It’s the rapid onset of extreme breathlessness along with a precipitous drop in the blood oxygen level due to fluid infiltration of the lungs. Pneumonia is one of the biggest causes of ARDS.

You did respond to your wife’s pneumonia. Its progression to ARDS is not something you or any doctor could have done anything about. ARDS is a medical disaster. Even when ARDS patients are put on a ventilator to help them breathe, they often succumb. And even when people pull through ARDS, many are left with scarred lungs and are dependent on oxygen for the remainder of their lives.

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.