DEAR DR. DONOHUE: I’d like to tell my story about tetanus shots. When I was 14 or 15, I worked on my grandfather’s potato farm and was dirty from head to toe. We picked up potatoes and put them in crates. My cousins, of which I had many (I am one of 52 grandchildren), all worked on the farm. I accidentally put my hand through a window and cut my wrist, which required stitches. Because I was so dirty, I was given a dose of tetanus antitoxin. My arm immediately swelled and ached all over. I lay on a couch for three days. From then on, I wouldn’t take another tetanus shot, but I became a nurse and had to have a booster. I took it, and several hours later my arm became swollen and fire-red. Ten years later, when the time for another booster came up, the doctor suggested taking half a dose. I did and got some swelling but nothing like the previous shots. I am 81 now and don’t think I’ll have another shot. — M.C.

ANSWER: Tetanus is a dreadful illness. The tetanus bacterium is widely found in soil and is also acquired from some indoor locations. The organism produces a poison (toxin) that causes severe and painful muscle spasms, including lockjaw. Adults are told to get a booster shot of the tetanus vaccine every 10 years. Few do.

When people talk about the tetanus shot, confusion arises. One shot is tetanus vaccine, called tetanus toxoid, a product made from the inactivated tetanus poison. It spurs the body to make antibodies that neutralize the bacterium’s poison. It takes a little time for those antibodies to arise. Therefore, tetanus antitoxin, a product containing antibodies to the poison, is given along with the vaccine for a contaminated wound. In these days, the antibodies are derived from humans. In the old days, they came from horses and caused many to react badly to the injection.

I believe your reactions happened mostly from the antitoxin, which, in those days, was probably the horse product. All the same, if I were taking care of you, I wouldn’t give you the vaccine or the antitoxin. It sounds like you react to both. People should realize the difference between the two shots. And people should get the vaccine every 10 years.

TO READERS: Many people have come down with the mysterious illness chronic fatigue syndrome. The booklet on it explains the illness and its treatment. To obtain a copy, write: Dr. Donohue — No. 304, 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: Help. My uric acid is elevated, which my doctor says is a sign of gout. I’m not a rich old man. I am a 75-year-old woman. The doctor recommends I drink cherry juice, which is expensive. Can I substitute cranberry juice? Can I control this with diet? — G.R.

ANSWER: High uric acid, which comes from the daily metabolism of cells, is associated with gout. You, however, do not have gout. You have asymptomatic hyperuricemia (HI-purr-YOUR-uh-SEE-me-uh), a higher-than-normal blood level of uric acid without having any signs or symptoms of gout. Two-thirds of people with such elevation in uric acid never develop gout. The cutoff point for blood uric acid is 7 mg/dL (416 mmol/L). Do you know how far above that number your uric acid is? Rich old men aren’t the only ones who get gout.

Neither of your two medicines raises the uric-acid level. Some water pills (diuretics) do. HydroDIURIL is one.

You’re not sitting on the edge of a cliff. Making some changes will bring down the uric acid without spending any money. If you’re even a little overweight, lose some pounds. Decrease your intake of red meat, and don’t eat organ meat like liver. Go easy with shellfish. Don’t drink pop. Dairy products lower uric acid. Low-fat dairy products are the best, since they do not raise cholesterol. Cut way back on any alcohol, especially beer, which boosts uric acid.

I have heard that cherries and cherry juice bring down uric acid. I can’t give you figures on how effective the cherry treatment is. I don’t believe it works. If you make the dietary changes I mentioned, you ought to see a drop in uric acid without spending a penny.

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.