What’s off the menu for gout?

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DEAR DR. DONOHUE: I am 84 and have gout. My doctor gave me indomethacin. It helps, but gout keeps coming back. What should I not eat? What else can be done for gout? – M.S.

ANSWER: Gout results when uric acid crystals make their way into joints. Everyone has uric acid in their blood. It’s the byproduct of the daily breakdown of body cells. Only a small part comes from the food we eat. When uric acid blood levels rise, that material, in the form of crystals, infiltrates joints. The blood buildup comes either from an overproduction of uric acid or from filtering too little of it into the urine. Most gout sufferers have kidneys that filter too little of it.

A gout attack is a memorable experience. The affected joint becomes red, swells and is so tender that even the touch of a sheet on the joint produces shockwaves of intolerable pain. The joint at the base of the big toe is often the first joint targeted, but the foot, ankle, knee, wrist, elbow and fingers can be involved.

One kind of gout medicine is for an acute attack. Examples are colchicine, prednisone and NSAIDs, nonsteroidal anti-inflammatory drugs like your indomethacin (Indocin).

For gout that keeps coming back, medicines that lower blood uric acid are prescribed. One is probenecid, which increases uric acid excretion into the urine. Zyloprim (allopurinol) stops the body’s production of uric acid. And sometimes as a treatment for recurrent gout, one of the NSAIDs or colchicine is given on a daily basis. This latter treatment is not working too well for you. You have the other options.

Diet is not as important as it once was, when there were few to no gout medicines. Alcohol can precipitate a gout attack, and among alcoholic drinks, beer is the worst offender and wine the least. Liver, kidney, anchovies, sardines, bacon, asparagus, kidney and lima beans, mushrooms and spinach can increase blood uric acid levels, so you should limit or eliminate these foods from your diet – not a terrible hardship. Cut down on red meat too.

The gout booklet provides more information on this illness and its treatment. People can obtain 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./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I had a small sore on my cheek that wouldn’t go away. I finally saw my doctor, who sent me to a dermatologist right away. The dermatologist biopsied the sore, and it turned out to be a squamous cell cancer. He then cut the sore out. Will it come back? How dangerous a cancer is it? – R.W.

ANSWER: Two common skin cancers are basal cell and squamous cell. Melanoma is a third common skin cancer, and the most dangerous of all. A squamous cell cancer is less dangerous than a melanoma, but more dangerous than a basal cell cancer. It can spread to distant body sites if not treated.

Removal of a squamous cell cancer almost always assures a cure. The five-year recurrence is 8 percent – not a huge number, but enough to warrant careful inspection of the skin on a regular basis by your dermatologist.

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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