DEAR DR. DONOHUE: Can you give me information about calcium pyrophosphate deposition disease? My orthopedic doctor told me I have it. I have had both hips replaced and now have knee problems. He told me there is nothing I can do regarding diet and exercise. The surgeon says joint replacement is the only way of treating it. I have faith in my doctor, but I realize he makes a living by doing surgery. I know gout can be controlled with diet. I wonder if the same applies to CPPD disease. – J.A.

ANSWER:
Calcium pyrophosphate deposition disease, CPPD disease, also goes by the name pseudogout – “pseudo” meaning “false.” It got that name because it mimics many gout symptoms. Nearly 15 percent of people between the ages of 65 and 75 have it, and as many as 40 percent of those 85 and older show signs of it. Many of these people have no symptoms. Some have acute attacks of joint pain, much like a gout attack. And some have a more chronic pain, similar to osteoarthritis. You have to keep in mind that people with CPPD disease also can have another form of arthritis at the same time. Osteoarthritis is usually that second form, and deciding which process causes the joint pain is often difficult.

A doctor can suction joint fluid from an involved joint and see the calcium pyrophosphate crystals with a microscope. Those crystals irritate cells, which release chemicals that inflame the joint. X-rays also show CPPD disease changes that are fairly typical.

The knees are the prime target of CPPD disease, but other joints can be affected: wrist, shoulder, ankle, hand, elbow and spine.

Anti-inflammatory drugs – Advil, Indocin, Aleve, Naprosyn and many others – ease pain and inflammation. Cortisone injected into an inflamed joint acts quickly. For repeated attacks, the gout medicine colchicine is used. Joint replacement is the final solution, as it is for many other forms of arthritis.

These days, diet plays a minor role in gout treatment. It was the only treatment for it at one time. Diet has no place in the treatment of CPPD disease, pseudogout.

DEAR DR. DONOHUE: My wife and I, both seniors, have been on a salt-free diet for several years. We seldom use iodized salt and seldom eat prepared foods. If we use no iodized table salt, are we in danger of developing a goiter? – G.L.

ANSWER:
Iodine deficiency can lead to thyroid gland enlargement – goiter – and there was a large section of the United States that used to be called the goiter belt because so many living there had goiters. The iodine deficiency was remedied by adding iodine to table salt. What about people who are now on a low-salt diet? Are they at risk for developing a goiter? The answer is no. People require only 150 micrograms of iodine a day. A microgram is a millionth of a gram and a gram is 1/30 of an ounce. That’s an amount smaller than a speck. Even on a low-salt diet, people still get enough iodine to meet their daily requirement. Salt can’t be and shouldn’t be completely eliminated from the diet.

Seafood provides iodine. Saltwater fish and shrimp have a good supply. So do dairy products. One cup of yogurt has 75 to 150 micrograms of iodine. Plants grown in soil near the ocean also contain iodine.

DEAR DR. DONOHUE: I am 78 and had five children. I feel something pushing through the vagina. An elderly doctor says it is tissue pushed out of place by my uterus. He said if it doesn’t bother me, I can ignore it. He also said I would need a complete hysterectomy. Is there a less-drastic solution? – B.W.

ANSWER:
Your uterus has dropped. Hysterectomy isn’t the only solution, if a solution is needed. The supports of the uterus can be reinforced to keep it propped up. Pessaries also might work. They’re donut-shaped devices that are inserted around the vagina to hold the uterus in place.

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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