DEAR DR. DONOHUE: I have had two gout attacks in my right big toe. My doctor wants me to take gout medicine all the time, not just when I have an attack. I don’t like the idea. Is there something else I can do to stop attacks? What causes one? – L.J.

Gout is one kind of arthritis, the kind that comes from uric acid crystals infiltrating joints to cause the agonizing pain of a gout attack. Uric acid is a byproduct of the daily breakdown and recycling of body cells.

The base of the big toe is a favored site for a gout attack. Other joints can also be involved. The knee is another favorite target.

People with a high blood level of uric acid can expect to have a gout attack. That’s not always true, but let’s leave it there.

As you say, there are two kinds of gout medicines. One is used for the acute attack. An example is the anti-inflammatory medicine indomethacin. It can generally calm an irritated, painful gouty joint. The second kind of medicine is medicine to prevent gout attacks. Those medicines either increase the excretion of uric acid into the urine or decrease the body’s production of it. People who have a high blood uric acid level and who have had a couple of gout attacks are encouraged to take one of these medicines.

Could diet changes be as effective a preventative as medicine is? It is still wise for gout patients to avoid foods with a high purine content – anchovies, legumes, gravies, organ meats (liver, brain, kidney), sardines and yeast. Purine is a precursor of uric acid. Alcohol should be drunk sparingly, if at all. Medicine, however, is much more effective than diet alone.

The newly published gout pamphlet provides greater information on this common illness. Readers 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 $4.50 U.S./$6.50 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I have been instructed to obtain a stool specimen in order to test for blood in it. How do I get the specimen? I have also been instructed not to take any aspirin or eat meat or raw fruits or vegetables for three days before obtaining the specimen. Why? – M.R.

Obtaining the specimen might be aesthetically displeasing, but it does not demand fine hand-eye coordination. With the small wooden spatula, usually provided to you, retrieve a pea-sized specimen of stool from the toilet bowl and smear it on the card your doctor has given you.

This test is a way to check for blood in the stool. It’s an indirect way of looking for cancer, since most colon cancers cause minute bleeding.

Aspirin can cause gastrointestinal bleeding, and blood from aspirin would invalidate the test. So do other anti-inflammatory drugs – Advil, Motrin, Aleve, etc. Vitamin C can interfere with a reliable test. It too should be avoided for three days prior to collecting the specimen.

Red meat, poultry, fish, raw fruits and vegetables – in particular, melons, cucumbers, cauliflower, radishes, turnips and horseradish – can yield a false positive test, so they must not be eaten for three days prior to obtaining the stool sample. Iron supplements must also be stopped in the three days preceding the test sample collection.

Not all stool blood tests require the above bans. The doctor is the one to give specific instructions for a fecal occult blood test, as it is called. “Occult” here means hidden, not mysterious or magical.

DEAR DR. DONOHUE: I have osteoporosis, and I take calcium and medicines to strengthen my bones. My doctor also told me to use salt sparingly. Why? I don’t have high blood pressure. – K.R.

Yours is the third letter I received this past week asking the same question.

Sodium (salt) increases the kidneys’ excretion of calcium. The low-salt diet is a way of maintaining a good level of body calcium.

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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