Dear doctors: My husband has "white-coat" hypertension in the form of highly elevated blood pressure whenever he goes to the doctor for his routine checkups. He has a blood pressure monitor at home and checks his blood pressure at least once daily. The machine was calibrated twice by the doctor and was found to be accurate. His readings at home are always 120 or less systolic over 80 or less diastolic with the home machine, but can be 160 systolic at the doctor's office. Does he need additional medication for his blood pressure?
D.D.
Reactive hypertension - high blood pressure resulting from a situational rather than a medical source - is very common. When it's the result of seeing the doctor (the "white coat" part), it can lead to overtreatment if not recognized. You and your husband have done exactly the right thing - bought and tested a home machine, and your husband regularly tests his blood pressure at home.
If the readings at home are consistently good and there are no other signs of poorly controlled blood pressure (the doctor may look at the back of the eyes, listen to the heart, check kidney tests or even get an echocardiogram to look for signs of damage from high blood pressure), then I would not recommend additional medication.
For others in the market for a home machine, home blood pres-sure cuffs that go around the upper arm, not the wrist or a finger, tend to be the most accurate. Definitely bring it in to the doctor so that it can be checked for accuracy. More blood pressure measurements mean better information for you and your doctor to decide about treatment.
Dear doctors: My son had a large collection of Matchbox cars from 35 years ago, when lead paint was used. He now has a son of his own. Should the cars be tossed out, or can they be played with once the baby no longer puts everything in his mouth?
L.S.
Matchbox cars, like other cars of that time, were made with lead paint. According to one source I found, Matchbox stopped using lead paint in 1961. However, you can purchase lead-testing swabs that can answer definitively whether a particular paint has lead in it.
I would not recommend letting small children use old toys that aren't proven lead-safe or that might have small parts that can come off. Safety standards are much higher now.
Dear doctors: I have mild diabetes and am taking metformin. In the spring, I planted a small vegetable garden with beans, peppers and tomatoes. I had a tremendous production. I have been eating these delicious vegetables on a daily basis for lunch and dinner for months. My question is: Are there good health benefits in the consumption of all these fresh vegetables, or can they cause any problem in the system?
J.P. There are many benefits from growing and eating your own vegetables. They have more nutrients than those bought in the store, and they taste wonderful. Vegetables are very much healthier than almost anything we eat, and a healthy diet helps to keep your diabetes under control. Your beans also have a good deal of protein. Many home gardeners feel a sense of pride eating their own produce, too.
Dear doctors: My fingernails are like tissue paper. What do you recommend?
B.L.
I have seen remarkable results from using silica gel as a supplement. I rarely recommend supplements, and always try to make my answers based on data, but I can't find a study that confirms what my clinical experience has told me. Silica gel can be very effective at making nails stronger.
Thin nails are most commonly caused by iron deficiency anemia, but can be caused by other, less-common conditions such as Plummer-Vinson syndrome, which usually has mouth pain and difficulty swallowing associated. Hyperthyroidism doesn't cause thin nails, but can cause the nails to split off of the nail bed and become brittle.
These are only some examples of actual diseases that affect nails, so a visit with a dermatologist might not be a bad idea if my suggestion doesn't work.