DEAR DR. DONOHUE: I am writing about my wife’s gout. She sometimes gets it so bad that she has to stay in bed and suffer. Will you please tell her what causes gout and what medicines she can take to control the pain? She has been to several doctors, and one told her he could give her a shot that would cost $1,300. There must be a less-expensive medicine to combat gout. – C.H.

ANSWER: There are effective gout medicines whose cost is nowhere near $1,300.

Gout comes from uric acid, a byproduct of daily cell turnover. Some people make too much of it or get rid of too little in the urine. In either case, the blood level rises, uric acid seeps into joints and trouble starts.

The affected joint or joints swell, turn red, become hot and feel like they’re being drilled with a burning poker. The joint at the base of the toe is often the first one targeted, but many other joints can become gout victims – the feet, the ankles, the wrists, fingers and elbows. Less frequently, shoulders, hips and the spine are attacked. Gout pain reaches a peak in a few hours and lasts for days or weeks.

Proof positive of gout is finding uric acid crystals in the joint fluid of an affected joint.

There are many effective and relatively cheap medicines that can bring an attack to a prompt end, and others that can prevent further attacks. For an episode of pain, a medicine like Indocin usually can stop pain promptly. For many years, colchicine was the drug used for acute attacks. It still is, and it still works well. In a few instances, an injection of cortisone into the joint can put an end to pain. To prevent gout, medicines like probenecid promote uric acid excretion, and allopurinol slows its production.

Your wife need not be suffering like she is. The family doctor usually can take care of most gout patients. If her problem is so special and so resistant to treatment, she needs to see a rheumatologist, the doctor for whom gout is a specialty.

DEAR DR. DONOHUE: I just read your article about gout. My uncle has it real bad. He is bedridden with it.

My problem with your article is what you said about alcohol. I am a regular beer drinker. In a day that I work around the house, I will drink eight to 10 cans, and I’ll drink three to five glasses of water. Needless to say, I urinate a lot. My uncle drinks a lot of water but doesn’t urinate often. So what is my point? I believe gout has more to do with fluid retention than drinking alcohol. Everything is made to be alcohol-related. I don’t think so. – Anon.

ANSWER: People who have gout often experience a gout attack after drinking alcohol. The alcoholic beverage that is most likely to precipitate an attack is beer. That is information that’s been verified by many. Alcohol might not cause gout in those who never had an attack, but for gout sufferers, it can lead to a repeat episode.

DEAR DR. DONOHUE: Would a CT scan confirm or deny the diagnosis of Alzheimer’s disease?

Recently, my cousin was given that diagnosis, which I find hard to believe. Yes, she does have an occasional lapse in memory; however, most of our friends her age have the same problem. Am I to believe they all have Alzheimer’s disease, or am I in denial? – L.C.

ANSWER: A CT brain scan cannot prove a person has Alzheimer’s disease. It can eliminate the possibility of other illnesses that have symptoms similar to Alzheimer’s disease. A brain tumor is an example of such an illness.

The only definitive proof for Alzheimer’s disease is microscopic examination of the brain. For most, an array of symptoms is sufficient proof. Minor memory lapses are not a sign of Alzheimer’s disease.

The topic of Alzheimer’s is discussed thoroughly in the booklet with that title. Readers can order a copy by writing: Dr. Donohue – No. 903, Box 536575, Orlando, FL 32853-6475.

Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

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