DEAR DR. DONOHUE: I’m just an old country woman who needs to know more about gout. I have it at least twice a year, and it’s so painful I can’t put my foot to the floor. Please list the things not to eat so that I can kind of keep it under control. – E.W.

DEAR DR. DONOHUE: I woke up with severe pain in my large toe. The pain got to be unbearable, and I then went to the emergency room. The doctor informed me I had gout. Please help me understand it. – W.B.

ANSWER: Uric acid crystals that bore their way into joints are the cause of gout. Uric acid is a byproduct of the daily turnover of body cells. As long as blood uric acid stays within a normal range, all is well. When its blood level rises, the uric acid infiltrates joints and causes intense joint pain, swelling, redness and heat.

Gout mostly happens to middle-aged to older men and to women who have gone through menopause. The base of the big toe is often the first joint to suffer an attack. Further attacks can target the heels, ankles, knees, elbows, wrists and fingers.

The definitive proof of gout is finding uric acid crystals in joint fluid. A rise in blood uric acid level is another tip.

The gout diet is not very restrictive. In the days before medicines effectively controlled gout, diet was the only remedy. It’s in second place these days. The consumption of red meat and especially organ meat (kidneys, heart, liver, brain and sweetbreads) should be minimized. It’s best to avoid gravies. Seafood, especially anchovies, sardines and shellfish, should be eaten in moderation. Alcohol – beer in particular – can provoke an attack. All vegetables and fruits are permitted, and low-fat dairy products appear to prevent attacks.

Gout medicines are of two varieties: ones for an acute attack and ones for prevention. Indomethacin is an example of medicine for an acute attack, as is colchicine. Zyloprim (allopurinol) and Benemid (probenecid) prevent attacks. Zyloprim decreases uric acid production, and Benemid enhances its excretion by the kidneys.

The pamphlet on gout discusses this common ailment in greater detail. 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 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: For four years I have been dealing with lichen planus. Is there any new treatment? – J.P.

ANSWER: Lichen planus is most often found on the skin of the wrists, ankles and legs. It can also find its way into the mouth. The genital skin, including the area around and inside the vagina, is another target. It starts as flat-topped, many-sided, small red patches that can merge into a larger patch. The color turns purple. White lines crisscross the surface of the patch. The outbreak is intensely itchy. A cause hasn’t been identified, but it might result from an immune system gone berserk. Sometimes it’s seen in conjunction with another illness, like hepatitis C.

The strongest varieties of cortisone creams and ointments are the usual treatment. Many patients are free of the condition in a year or so. To prevent relapses, some have to keep applying the ointments on a less-frequent basis once the skin has cleared.

DEAR DR. DONOHUE: I read your article on dry eyes. My wife has this problem. She was examined by an eye doctor, who advised GenTeal gel, an eye ointment. She has been using it regularly since 2002, and it has worked wonders for her. It is relatively inexpensive. – P.K.

ANSWER: Many thanks for letting people with dry eyes know how well your wife has done with the product. It also comes as a solution of artificial tears.

People with dry eyes must first find out what’s causing the problem. One of the big causes is Sjogren’s syndrome, which also can produce dry mouth.

DEAR DR. DONOHUE: My wife, 76, has degenerative arthritis of the spine. Can you tell me if this condition will progress to total disability? – J.D.

ANSWER: Degenerative arthritis is another name for osteoarthritis, the most common kind of arthritis. Almost every 70-year-old has a touch of it. It can be in the back, knee, hip, hand, fingers and ankle, or any of these locations. The rate of progression is unpredictable. A good many can continue to do most of the activities of life with minimum disruption.

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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