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Q. I used Preparation H for some hemorrhoid irritation in the morning before I saw my doctor for a normal checkup. I almost broke the blood pressure machine. They measured my blood pressure three times because it was so high.

I was trying to think what I might have done to account for this. Then I read the label on Preparation H and put two and two together.

I wonder how many people have landed in the emergency room because they couldn't handle this stuff. It seems to me the warning should be clearer.

A. The label on Preparation H Ointment advises consumers to "ask a doctor before use if you have heart disease, high blood pressure, thyroid disease, diabetes or difficulty in urination due to enlargement of the prostate gland."

People may not realize that medication inserted into the rectum is likely to be absorbed into the bloodstream and circulate throughout the body. Because Preparation H contains a vasoconstrictor called phenylephrine, it may raise blood pressure in susceptible people. You also may have experienced white coat hypertension brought on by stress in the doctor's office.

Q. I read recently that women who take vitamins die sooner than women who don't. That puzzled me, but the vitamin I am especially concerned about is vitamin D. My doctor has made it clear that if I don't get enough, I am risking weak bones.

How would I know if I were vitamin D deficient? If I were, how should I get more? And isn't vitamin D one of those that can be toxic?

A. Results from the Iowa Women's Health Study surprised many researchers with the finding that a number of supplements, especially copper and iron, were associated with a higher risk of death during the two decades it lasted (Archives of Internal Medicine, Oct. 10, 2011). Although the scientists collected data on vitamin D use, women who took this vitamin were no more likely to die during follow-up.

In fact, vitamin D is crucial for bones, heart, muscles and the immune system. We offer our Guide to Vitamin D Deficiency, with advice on how to tell if you're deficient and what to do about it. Anyone who would like a copy, please send $3 in check or money order with a long (No. 10), stamped (64 cents), self-addressed envelope to:

Graedons' People's Pharmacy

No. D-23, P.O. Box 52027

Durham, N.C. 27717-2027

It also can be downloaded for $2 from peoplespharmacy.com. There is a list of vitamin-D-rich foods and guidelines on how much you should be getting to avoid toxicity.

Q. I read in your column that Cialis is now indicated for benign prostate enlargement (BPH). I am very interested in this treatment, but I expect my doctor will be skeptical. Where can I find documentation to show him?

A. The documentation that the Food and Drug Administration has approved this new use can be found in the official prescribing information. While this kind of information used to be available almost exclusively in the Physicians' Desk Reference, it is now readily available online at DailyMed.nlm.nih.gov.

Your doctor may be interested in a recent study from the Journal of Sexual Medicine (online, Oct. 7, 2011). A 5 mg dose of Cialis improved erectile dysfunction and symptoms of prostate enlargement.