DEAR DR. DONOHUE: I am writing to you on behalf of my son-in-law. He has gout. I would like information on this disease. My son-in-law wonders if there is a doctor that specializes in gout. — J.W.
ANSWER: When the blood uric acid level rises, a gout attack is imminent. Uric acid comes from the daily turnover of cells. Levels rise either because the kidneys aren’t getting rid of it in the urine or because the body is making too much of it.
Uric acid from the blood seeps into joints as needle-shaped crystals. The joint swells, turns red and hot, and hurts with pain beyond description. An attack comes on suddenly, in a matter of hours. The joint at the base of the big toe is often the first joint attacked, but knees, ankles, feet and other joints can be gout victims.
Your son-in-law has to take some anti-gout steps on his own. Weight loss is one. He has to use alcohol sparingly and give up beer. Of all alcoholic drinks, beer is the worst for gout patients. A gout diet is simple: Cut back on red meat and seafood. They don’t have to be eliminated, just reduced. Low-fat dairy products are encouraged.
Today’s gout patients live at a time with excellent gout control medicines. Ones for an acute attack include drugs like naproxen, ibuprofen and indomethacin. Colchicine, a gout medicine used for many decades, is still used and still works. Prednisone is turned to if other medicines fail.
The second kind of gout medicine is medicine to prevent further attacks. When people have three or more attacks a year, have fewer but more severe attacks or have complications of gout like kidney stones, then the preventive medicines are called into play. Allopurinol (Zyloprim) stops the production of uric acid. Probenecid enhances its excretion in the urine. A new drug, Uloric, can step in if the others are not working. It is expensive.
A rheumatologist is a specialist in joint illnesses, including gout.
The booklet on gout presents the details of it and its treatment. Readers can order a copy by writing: Dr. Donohue — No. 302, 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: For almost a week, I suffered from a dull pain in my sinuses and a thick discharge from my nose. I was sure I had sinusitis.
I saw my doctor hoping for antibiotic treatment. After examining me — and he was quite thorough — he said I didn’t need any antibiotics. I am over it now, but I know I would have been over it sooner if the doctor had given me antibiotics. Do you agree? — K.J.
ANSWER: I agree with your doctor.
About eight out of 10 people seeing a doctor for the symptoms you describe would leave the doctor’s office with an antibiotic prescription. It’s been shown that antibiotics for a condition like this do no more good than does a placebo, a fake pill.
A somewhat surprisingly large number of people actually come down with side effects from the antibiotics. Antibiotics are not without potential complications. Furthermore, indiscriminate use of antibiotics leads to antibiotic resistance and the emergence of super germs. Shake your doctor’s hand for me. Stick with him. He’s a good doctor.
DEAR DR. DONOHUE: Fifteen years ago I was diagnosed with hypothyroidism. Since then I have been taking levothyroxine (Synthroid or Levoxyl). Would thyroid extract containing iodine work just as well? Should I be tested more than once a year? — M.B.
ANSWER: By thyroid extract, do you mean desiccated thyroid obtained from the thyroid glands of pigs? If you’ve been getting along fine with levothyroxine — the most prescribed thyroid-replacement medicine — you have no reason to switch. All thyroid preparations have iodine in them. It’s part of the thyroid hormone molecule. Once-a-year testing is sufficient.
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.