DEAR DR. DONOHUE: I have gout in my big toe, and it’s very, very painful. I have to walk in my socks. Are there any pills for gout? What food causes the pain? – L.K.

ANSWER: Gout results from too much uric acid in the blood. Uric acid is byproduct of daily cell chemistry. When the uric-acid level rises, crystals of it penetrate the joint. The joint swells, the skin over it turns red, and the joint feels warm. It hurts beyond words. Early on, gout comes in attacks, with the intervals between attacks being free of pain. As time passes, the joint can hurt all the time. The joint at the base of the big toe is often the first joint affected, but it might not be the only joint. The heel, the ankle, the knee, fingers, wrists and elbows also can be targets.

Doctors make the diagnosis of gout by examining the affected joint and finding a high blood uric acid. The most telling evidence lies in looking at joint fluid through a microscope and seeing uric-acid crystals.

Are you positive it is gout that you have? Many conditions cause swollen, painful joints.

For acute gout attacks, nonsteroidal anti-inflammatory medicines like Indocin work well. Another time-honored gout medicine is colchicine. If neither of these works, cortisone drugs come to the rescue.

Zyloprim (allopurinol) turns off the production of uric acid and prevents gout attacks. Benemid (probenecid) facilitates the excretion of uric acid into the urine. It, too, prevents attacks.

Diet was the sole treatment of gout in the bad old days. Organ meats – liver, brain, sweetbreads and kidneys — are foods to avoid. Gravies are not good for those with gout. Beer should be restricted. Bing cherries can bring the blood level of uric acid down.

DEAR DR. DONOHUE: My doctor told me that I have costochondritis. I have had it for five days, and my chest is sore to the touch. It makes me short of breath. I am on ibuprofen, but it doesn’t seem to help. Is there anything else I can take? – D.H.

ANSWER: The “costo” of costochondritis is “ribs”; the “chondr,” is “cartilage”; the “itis,” inflammation. It’s an inflammation of the cartilage attaching ribs to the breastbone.

Costochronditis is especially painful when taking in a breath or when twisting the chest.

No one is sure what the cause is.

Your medicine and similar ones are the standard treatment for this condition. Heat, in the form of warm compresses or heating pads, eases the pain. Some find that cold works better. If the pain persists, the doctor can inject the area with cortisone. That usually brings quick relief.

Most are well in weeks to months.

DEAR DR. DONOHUE: As a calorie counter from way back, will I lose weight if I eat 1,500 calories a day? How about if I eat 1,200 calories one day and 1,800 the next? – K.T.

ANSWER: If you burn more than 1,500 calories a day but take in only 1,500 calories, you should lose weight.

You can still lose if one day you take in slightly more and the next day slightly less. You can count the calorie deficit over a week’s time.

DEAR DR. DONOHUE: My adopted little sister was sexually abused by her father when she was really young. Do you think this led to her starting periods early, at age 9? – D.M.

ANSWER: The average age for the onset of periods is 12, but the range runs from age 9 to 16. Your sister is young, but still within the normal range. Most girls (95 percent) have their first period between 10.5 and 14.5.

Sexual abuse is not usually considered a cause of early menstruation.

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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