DEAR DR. DONOHUE: I am 86. My son is 56. He has gout, as did his father. My husband was on a very strict gout diet. My son doesn’t watch what he eats. He eats everything. He even drinks beer with his dinner. The doctor forbade my husband to drink any alcohol. Is this a change in gout treatment, or is my son choosing not to follow a gout diet? – J.B.

ANSWER:
Gout arises from the infiltration of uric acid into joints. Uric acid forms iciclelike crystals in the joint. They make the joint hurt, swell and become hot and red.

A rise in the blood level of uric acid causes it to diffuse into joints. The blood level rises either because the kidneys do not excrete it as they should or because the body produces too much of it. Nine times out of 10, the rise comes from the kidneys failing to filter it into the urine.

The actual source of uric acid is food or the body’s own production of it. Uric acid arises from the daily breakdown and processing of body cells. Most blood uric acid comes from the recycling of body cells.

In your husband’s day, the chief attack on gout was control of uric acid by diet. Foods with a high purine content (purine transforms into uric acid) were verboten and still are. They include anchovies, kidney, game meats, gravy, herring, liver, sardines, scallops and sweetbreads. Gout patients today are still warned to avoid these foods. In the past, all meat products and “rich” foods were proscribed.

Today, with the availability of medicines to control blood uric acid, the gout diet is not hard to follow. I could live without any of the foods on the above list without feeling sorry for myself. Alcohol can increase uric acid production and slow uric acid excretion. However, if a gout patient does not suffer an attack after drinking alcohol, a moderate amount is permissible.

Readers who would like the complete gout story can obtain it by ordering the gout pamphlet. Write to: Dr. Donohue – No. 302, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.50 U.S./$6.50 Can with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: Exactly what are crabs? How does a person get them? My boyfriend came back from a business trip with them and gave them to me. He says he caught them from sleeping in a cheap hotel. Can that be possible? – L.L.

ANSWER:
Crabs are pubic lice. A magnified picture of a pubic louse looks very much like a crab.

Sexual transmission is the way for most people to catch them. However, they can live on bed linens and on clothes for a short time, so transmission via those routes is theoretically possible. But it is not a common means of spread.

DEAR DR. DONOHUE: Please let me relate my experience with generic drugs. I think the public ought to know about them. I had been on a blood pressure medicine for years and years without any trouble. My insurance company told me that I had to take the generic form of the drug. Guess why. It is cheaper.

I did so. After one week of taking the generic drug, I broke out in hives. I was allergic to the generic drug. Since going back on the brand-name drug, I have had no trouble. – G.R.

ANSWER:
When the patent on a drug runs out, other manufacturers are allowed to produce the same drug. Their product must have the same amount of active drug that the original brand-name drug had.

The dye the new manufacturer uses to color the drug and the inert ingredients in the pill, tablet or capsule can differ from those of the original brand-name drug.

You did not have an allergic reaction to the drug itself. You had an allergic reaction to the dye or one of the “filler” materials used to compound the generic drug. It happens, but not commonly.

People should not think generics are dangerous.

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.


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