DEAR DR. DONOHUE: Last month, my husband awoke from sleep with such pain in his big toe that I had to take him to the hospital. After waiting hours and hours for the results of tests, the doctor told us he was having a gout attack and gave him medicine to ease the pain. He was instructed to follow up with his own doctor, which he has done. He is not on a special diet. Why not? He won’t let me talk to the doctor. – N.P.

ANSWER: Few illnesses rival the pain of a gout attack. The first attack usually happens at the joint at the base of the big toe, but it and subsequent attacks can occur in the foot, the ankle, the knee, the elbow, the wrist or the fingers.

Gout comes about from a buildup of uric acid in the blood. The uric acid seeps into joints and forms needle-like crystals that bring on gout pain.

Uric acid is a byproduct of body metabolism. The excess comes from the body making too much of it, not disposing enough of it or from the diet. About 90 percent of gout patients fall into the category of not passing sufficient uric acid into the urine for elimination.

Now that we have such effective gout medicines, diet takes a back seat in treatment. It cannot be totally ignored, but its importance has diminished from the days when there were no effective drugs. Gout patients should limit their intake of red meat and seafood. Doctors used to give patients a list of purine foods to avoid. The body turns purines into uric acid. On the list were vegetables like peas, beans, lentils, spinach and cauliflower, because they have a high purine content. Evidence shows, however, that these foods do not raise blood uric acid levels, so they can be eaten. Low-fat dairy products act to prevent gout attacks, and your husband should incorporate lots of these foods into his diet. Alcohol can precipitate an attack, and beer is the alcoholic beverage most notorious for doing so.

The booklet on gout goes into this subject in depth. To order a copy, write: 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: All my life I have lived in a sunny climate and have spent a great deal of time outdoors. I am 45. I have a reddish patch on my face that the doctor says can turn into cancer. He wants to freeze it off. It is not sore, and the skin is intact. Is this necessary? – R.M.

ANSWER: Did the doctor call it an actinic keratosis? Such skin lesions come from overexposure to the sun throughout life. They are pink, red or flesh-colored and either flat or slightly elevated. They range from very small to almost an inch in diameter. The surface is usually scaly and feels gritty to the touch.

Yes, it’s necessary to remove them. Your doctor isn’t kidding you. They can evolve into skin cancer.

Freezing them off with liquid nitrogen is a standard treatment. It works well, but it can be used only if there are a small number of actinic keratoses. It often takes a couple of sessions to remove the keratosis completely.

Another treatment is fluorouracil cream, which is self-applied. Treatment continues for two to four weeks. Two brand names are Efudex and Fluoroplex.

DEAR DR. DONOHUE: Is carob a healthier food than chocolate? I love chocolate, and I don’t want to deprive myself of it if it’s not necessary. What do you say? – J.M.

ANSWER: Carob is a chocolate substitute. It has less fat than chocolate but, when used for candy, manufacturers generally add fat to give it the texture and taste of chocolate. It has more sugar than chocolate.

Dark chocolate has become a health food – almost. It is said to lower blood pressure, lower bad cholesterol, increase the body’s responsiveness to insulin and thereby keep blood sugar normal, dilate arteries to increase blood supply to organs and stop clot formation like aspirin does. However, 1 ounce has up to 150 calories, so it should be eaten in moderation.

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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