DEAR DR. DONOHUE: I am a man of 64 years. Please discuss gout. — J.R.

ANSWER: In the bad old days, people believed gout to be the illness only of aristocrats who ate rich foods and drank fine wine. Now it’s an illness for everyone, but mostly it’s a man’s illness.

Gout occurs when the blood uric acid level rises. Uric acid is a byproduct of daily cell recycling. People with gout either have kidneys that don’t get rid of uric acid or bodies that produce too much of it. Uric acid in the blood penetrates joints and inflames them. The joint at the base of the big toe is gout’s favorite target, but it also strikes ankles, knees, hands and elbows.

During a gout attack, the affected joint turns red, becomes hot and cannot stand the slightest pressure. Pain can be intolerable. The diagnosis of gout is established definitively by finding uric acid crystals in the fluid drained from an involved joint and seeing uric acid crystals in it through microscopic examination.

In the old days, diet was its only treatment. In the good new days, medicines control it. Nonsteroidal anti-inflammatory medicines like Indocin (indomethacin) bring fairly rapid relief from a gout attack. Colchicine, an older drug, is still used, but less often than it used to.

To prevent gout attacks from recurring, Zyloprim (allopurinol) stops uric acid production. Or Benemid (probenecid) prods the kidneys to remove more of it. A new drug, Uloric, also puts a halt to uric acid production. It is handy for those who have trouble taking either of the older standbys.

If you are overweight, weight loss is another way to prevent further attacks. Low-fat dairy products also lessen their occurrence. Diet isn’t the concern it used to be when there were no gout medicines. Patients should avoid organ meats — kidneys, brain, liver and sweetbreads. They also should steer clear of anchovies, fish eggs, bouillons, gravies and often alcohol, especially beer.

The gout booklet explains the details of this illness. Readers can obtain a copy by writing: 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: I am a 64-year-old woman just diagnosed with a torn meniscus of the knee. I wear a knee brace with steel inserts in the sides. The doctor tells me it is a long healing process. What is the meniscus? Can you hasten healing? — C.G.

ANSWER: The knee has two menisci, a medial one (on the side facing the opposite leg) and a lateral one (on the other side of the joint). A meniscus is a crescent-shaped, thick wafer of cartilage that permits a better fit of the thigh bone into the joint and serves as a cushion for all the stresses the knee endures. The medial meniscus is the one more often torn. A twisting motion of the knee while bearing weight is the maneuver responsible for most torn menisci. Getting out of a car seat is an occasion of tearing, in many cases. Of course, this is a common football injury.

Sometimes the torn fragment pops upward and causes the knee to lock in a certain position.

Menisci have a poor blood supply, and that’s one reason why they take so long to heal. There’s nothing you can do to speed things along. If the pain doesn’t go away or if locking becomes a problem, surgery is the answer.

DEAR DR. DONOHUE: I think I may have the illness where a person pulls out clumps of hair. I’m not sure of the name. I find I do this after I have caffeine. I have been off caffeine for 25 years, and I do not pull my hair out. I thought this might be helpful to others. — K.H.

ANSWER: The name of the condition is trichotillomania (TRICK-oh-TILL-uh-MAY-knee-uh). Between 4 million and 11 million Americans have it. It’s called an impulse disorder. I hadn’t heard about a caffeine connection. If this holds true for others, they will deeply appreciate your advice.

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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