DEAR DR. DONOHUE: I’ve just been told I have high blood pressure. Only the first number of my reading is high. The second one is normal. I always thought that a high first number wasn’t such a big deal, especially at older ages. Has the thinking on this changed? I am 77 and don’t like the thought of being less than perfect. — G.D.

ANSWER: The two numbers of a blood pressure reading are the systolic pressure (first number) and the diastolic pressure (second number). The systolic pressure is the pressure imparted to blood by the pumping action of the heart. The diastolic pressure is the pressure that remains in the blood between heartbeats. Both pressures keep blood circulating.

In the not-so-distant past, greater attention was given to diastolic pressure. Higher-than-normal systolic pressures were permitted at older ages. The thinking has changed. Now we know that systolic pressure causes as much damage as diastolic pressure, and it might even be a greater threat to older people than an elevation of the diastolic pressure. A normal blood pressure is one less than 120/80. High blood pressure is one where the first number is greater than 140 (systolic pressure) or the second number is higher than 90 or both are elevated. If the first number is the only high number, the condition is called isolated systolic hypertension, and it does require treatment.

Maybe some things you do on your own can restore you to a state of perfection. Adopt a low-salt diet consisting mostly of fruits, vegetables and whole grains. Meats should be lean and limited to 6 ounces a day. Try to boost your intake of potassium-rich foods — baked potatoes with their skins, sweet potatoes, bananas, tomatoes, lima beans, soy beans, prunes, squash, spinach, cantaloupe, orange juice and almonds. Weight loss lowers blood pressure. So does daily exercise, like brisk walking.

The same medicines used for elevations of both numbers are used for isolated systolic hypertension.

The booklet on high blood pressure describes the details of this common disorder. Readers can order a copy by writing: Dr. Donohue — No. 104, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: What can you tell me about pulmonary fibrosis? How long does a person live after he or she is diagnosed with it? How does it start? Is it genetic? — K.W.

ANSWER: Fibrosis is the laying down of strands of scar tissue. “Pulmonary” indicates this process is taking place in the lungs. Its cause is still unknown, so the full name is idiopathic pulmonary fibrosis, “idiopathic” meaning “cause unknown.” The influence of genes is also unknown.

Usually it appears in a person’s 50s, and it often has been present for months or years before the diagnosis is finally made. Early symptoms can be mild. The fiber strands interfere with the passage of oxygen into the blood, so shortness of breath is its primary symptom. Breathlessness can progress to feeling winded even when seated.

Supplemental oxygen often is required. Immunizations with the pneumonia and flu vaccines are most important.

Combination therapy of prednisone — one of the cortisone drugs — with azathioprine is a regimen adopted by many doctors. Lung transplant is another consideration. Predictions on longevity are futile. Much depends on how greatly the lungs are affected and how quickly the disease progresses.

DEAR DR. DONOHUE: Have you ever heard of proctalgia fugax? What is it? How do you get rid of it? — D.

ANSWER: Proctalgia (prock-TAIL-juh) fugax (FEW-jacks) is rectal pain of short duration, lasting from seconds to minutes. It most often comes on at night and is believed to represent spasms of the rectal muscles. Soaking in a warm tub before bedtime (if attacks are numerous), sitting on a clenched fist and getting up for a short walk are ways to relieve pain.

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. Readers may also order health newsletters from www.rbmamall.com.

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