DEAR DR. DONOHUE: I am a 63-year-old woman, and I have gout. I can’t believe it. I thought only men got it. How did I get it? Do I have to take medicine for it for the rest of my life? How does the medicine work? – A.D.

ANSWER: You got gout like everyone else gets it – from a rise in blood uric acid. Uric acid is a byproduct of all the chemical processes that take place in body cells. When blood uric-acid level rises, it can diffuse into joints. Inside the joint, uric acid crystallizes, and those crystals irritate and inflame the joint. The involved joint swells, turns red, becomes hot and is exceedingly painful. In a first gout attack, the big toe is the joint affected the majority of the time. However, any joint can be a target – chiefly the midfoot, the ankles, the knees, the wrists or the fingers.

Before menopause, few women come down with gout because estrogen promotes uric-acid excretion. By age 60, the number of women with gout equals the number of men, and by age 80, more women suffer from it than do men.

Uric-acid levels rise either because the kidneys fail to get rid of it as they should or because the body overproduces it. Nine times out of 10, the fault lies with the kidneys’ inability to excrete it normally.

There are two classes of gout medicine. One class handles the acute attack. Anti-inflammatory medicines like Indocin are often chosen when a joint becomes painfully swollen with uric-acid crystals. Colchicine, a time-honored gout medicine, is still used, but because it can cause some unpleasant side effects, it is often held in reserve.

The second class of gout medicines are ones used to prevent recurrent attacks. Two common ones are Benemid, which promotes uric-acid excretion, and Zyloprim, which reduces its production.

Lifelong therapy is instituted if a person has recurring and frequent gout attacks.

The gout booklet explains this illness in depth. To obtain a copy, write to: Dr. Donohue – No. 302, Box 536475, 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.

DEAR DR. DONOHUE: I have been taking Zyloprim (allopurinol) for gout for 10 years. My neighbor stopped taking it because he was informed that continuous use of this drug leads to dementia or Alzheimer’s disease. Please advise me if this is true. – P.B.

ANSWER: This medicine has been around for a very long time. I have not seen any reports that link it to dementia or Alzheimer’s disease. It’s used by thousands. If such a link were true, it would be a major news item.

DEAR DR. DONOHUE: I suffer from episodes of proctalgia fugax. In researching it, I have found that episodes last only for several seconds to several minutes. I have episodes that last for more than one hour. They are incredibly painful.

Some years ago, you wrote about the possible use of topical nitroglycerin ointment to relieve it. When I talk to doctors about this, they look at me blankly and say they don’t know anything about the way to mix it. Can you provide more details? — B.P.

ANSWER: Proctalgia fugax is severe rectal pain that can come on at any time but most often does so at night and wakens a person from a sound sleep. For most people, the pain lasts only a short time – 15 minutes at most. You are an exception.

An unproven but reasonable explanation of what happens is that rectal muscles go into a spasm, not unlike a muscle cramp.

At one time I did write that nitroglycerin ointment could possibly be effective in ending a spasm. It’s the nitroglycerin ointment, 2 percent, used for angina chest pain, and it is readily available. I’m not recommending it anymore. Fewer reports substantiate its effectiveness. Sitting in a tub of warm water or sitting on a closed fist might put an end to an episode.

DEAR DR. DONOHUE: What age am I? I was born 9/24/1926. I thought I was 78, but I am told I am 77. – K.H.

ANSWER: The way I figure age, you are 78: 2004 minus 1926. You’ll be 78 till 9/24/2005. On 9/24/1927 you were 1, right? 1927 minus 1926. This isn’t a medical question, but it’s a Donohue family question that caused many unpleasant exchanges between Mr. and Mrs. Donohue.

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.