Gout now an illness of the common man

DEAR DR. DONOHUE: Please write something about gout. I’m new to it. I had my first attack a month ago, and it was the worse pain I ever had. It’s in my big toe. I got treatment that helped immensely, but I live in fear that it will come back. Will it? Should I be on a special diet? I’m not. — G.R.

ANSWER: Gout was once considered an illness of aristocrats, who ate sumptuously and drank excessively. Now it’s an equal-opportunity illness, with one exception: For every woman with gout, five men have it. A prolonged elevation of blood uric acid allows the uric acid to infiltrate joints as needle-thin crystals. That’s the cause of an attack. Uric acid is a byproduct of daily cell turnover. Our kidneys get rid of it for us. People with gout have either a decreased uric acid excretion or an increased production.

A gout attack is torture in the extreme. The base of the toe is the joint most often affected in a first attack, but other joints are vulnerable — the heel, foot instep, ankle, knee, elbow, fingers and wrists. An attack builds to a peak of pain in 12 to 24 hours and can last for a week or more without treatment. Treatment of an acute attack includes drugs like indomethacin, ibuprofen, naproxen or colchicine, and the pain responds usually quite rapidly.

Without treatment, after an attack, most will experience a second one within two years. All patients need a medicine to lower their uric acid, and that can be done with medicines that stop its production (Zyloprim and the first new gout medicine in 40 years, Uloric) or increase its elimination (Benemid). A low blood uric acid lessens the chances for a repeat attack.

Diet is not as important as it once was. Alcohol has to be limited or eliminated. Beer is the alcoholic drink most likely to lead to an attack. Gout patients have to give up organ meats (liver, kidney, heart and sweetbreads), caviar, sardines, herring, mackerel and cod, and they have to go easy with gravies. These are high-purine foods, foods that increase uric acid.

The gout pamphlet provides more information on this common illness. People can order 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: Can anyone drink white or green tea? Is there any medication that may react with it? I mean, does it stop certain medicines from working? — H.E.

ANSWER: Anyone who wants to can drink white or green tea. All teas — black, green and white — come from the same plant. Different ways of processing the tea leaves produce the black, green and white varieties. Green tea undergoes less processing. Tea leaves are steamed, rolled and then dried. For black tea, the tea leaves undergo similar processes, but they also are exposed to oxygen. The oxygen turns the leaves dark and imparts a stronger flavor. White tea is obtained by picking young tea leaves and white tea leaf buds. These leaves are only steamed and dried. All teas share similar components, but the processing does change some of their constituents.

A question arises about teas’ (all varieties, but more so with black) interference with iron absorption. If there is an effect, it is so small that it doesn’t raise a concern. Green tea has been said to decrease body folate, one of the B vitamins. Again, the effect is not a health concern.

DEAR DR. DONOHUE: I am an 85-year-old man and am being treated for a thing called temporal arteritis. I started with 60 mg of prednisone, but am now on only 5 mg. I am 6 feet tall, weigh 250 pounds and have a 50-inch waist. My problem: I never had much length to my penis, but now I am lucky to find it. What gives? — R.S.

ANSWER: The prednisone, a cortisone medicine, is partially responsible for your extra weight. Now that you are down to a small dose of 5 milligrams, you can start shedding some pounds. I believe your problem has occurred because body fat has buried your penis.

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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