DEAR DR. DONOHUE: I just had my first bout with gout. I assume it was gout. My husband and I had a wonderful dinner of steak, salad and prawns fried in butter with a few glasses of Scotch. The next morning when I awoke I had a swollen ankle and could not put any weight on it. The pain and swelling passed in a few days. Could it have been gout? – S.A.

The usual sequence of events that ends in a gout attack goes like this. When blood uric acid levels rise, some uric acid seeps into a joint and detonates the explosion of a painful gout attack. The base of the big toe is the usual site for a first gout attack, but there is no law that says the ankle or knee cannot be the target.

Food plays a minor role in uric acid rise. Impaired excretion of uric acid or a too-exuberant production of it are the chief reasons for an elevation.

Only a few foods elevate blood uric acid. Alcohol is one of them, and it can precipitate an attack. I can’t say if you had a gout attack or if it was your sumptuous feast that caused it. Some elements of your story don’t ring true for gout. An untreated attack often lasts five to 10 days. In most instances the pain is so severe that it forces a person to consult a doctor. You have to be quite stoical to endure a gout attack without taking medicines.

I don’t want to leave you adrift, but all I can offer is this advice: Either now or when you have a second attack, high-tail it to a doctor to get your blood uric acid checked. During an attack, proof of gout is established by finding uric acid crystals in joint fluid. Blood evidence is not enough to convince a jury. A second attack coming on in the weeks or months after a first attack also establishes a diagnosis of gout. (A repeat attack is common after having a first attack.)

DEAR DR. DONOHUE: I was surprised to read your article on urinary tract infections and your recommendations to use antibiotics.

We all know they should be used as sparingly as possible, especially when there is a safe, predictable and more holistic cure.

After suffering for years with this problem, it always recurred after antibiotic treatment. I experimented with cranberry extracts and have been on them for the past seven years without having a recurrence.

Maybe you could devote some column space to this treatment. – T.B.

I am a cranberry fan. There is something in the berry that makes it impossible for the most common urinary-tract-infection bacterium to cling to the bladder wall.

You can take your cranberries as juice or tablets or make your own mixture by crushing fresh cranberries, sweetening them with honey and diluting the mixture with water according to your taste. I can’t tell you the exact amount. No one knows for sure.

The cranberry is not a treatment for an actual infection. It might work as prevention of infection.

DEAR DR. DONOHUE: My brother-in-law had the same experience as the man who became dizzy when rising from a chair. A young doctor in a small hospital south of Montreal discovered that he had fluid on the brain. A shunt was installed, and he is now living a full life again. – L.W.

Your brother-in-law had normal pressure hydrocephalus, a condition where too much cerebrospinal fluid collects in the hollow caverns of the brain. The caverns enlarge and thin the brain’s gray and white matter, where nerve cells and their cables are located. The three tip-off symptoms of NPH are walking impairment, mental deterioration (inability to do simple functions, such as check writing, and an ever-increasing forgetfulness) and loss of urine control. Dizziness on rising is not a common symptom. Draining the brain fluid through a tube into the abdomen can restore mental function to many patients.

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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