Ask the Doctor: Disorder Can Be Controlled
DEAR DR. DONOHUE: I am writing to you on behalf of my son-in-law.
He has gout. I would like information on this disease.
My son-in-law wonders if there is a doctor that specializes in gout. - J.W.
ANSWER: When the blood uric acid level rises, a gout attack is imminent.
Uric acid comes from the daily turnover of cells.
Levels rise either because the kidneys aren’t getting rid of it in the urine or because the body is making too much of it.
Uric acid from the blood seeps into joints as needle-shaped crystals.
The joint swells, turns red and hot, and hurts with pain beyond description.
An attack comes on suddenly, in a matter of hours.
The joint at the base of the big toe is often the first joint attacked, but knees, ankles, feet and other joints can be gout victims.
Your son-in-law has to take some anti-gout steps on his own.
Weight loss is one.
He has to use alcohol sparingly and give up beer.
Of all alcoholic drinks, beer is the worst for gout patients.
A gout diet is simple: Cut back on red meat and seafood.
They don’t have to be eliminated, just reduced. Low-fat dairy products are encouraged.
Today’s gout patients live at a time with excellent gout control medicines.
Ones for an acute attack include drugs like naproxen, ibuprofen and indomethacin.
Colchicine, a gout medicine used for many decades, is still used and still works.
Prednisone is turned to if other medicines fail.
The second kind of gout medicine is medicine to prevent further attacks.
When people have three or more attacks a year, have fewer but more severe attacks or have complications of gout like kidney stones, then the preventive medicines are called into play.
Allopurinol (Zyloprim) stops the production of uric acid.
Probenecid enhances its excretion in the urine.
A new drug, Uloric, can step in if the others are not working.
It is expensive. A rheumatologist is a specialist in joint illnesses, including gout.
DEAR DR. DONOHUE: Fifteen years ago I was diagnosed with hypothyroidism.
Since then I have been taking levothyroxine (Synthroid or Levoxyl).
Would thyroid extract containing iodine work just as well? Should I be tested more than once a year? - M.B.
ANSWER: By thyroid extract, do you mean desiccated thyroid obtained from the thyroid glands of pigs?
If you’ve been getting along fine with levothyroxine - the most prescribed thyroid-replacement medicine - you have no reason to switch.
All thyroid preparations have iodine in them.
It’s part of the thyroid hormone molecule. Once-a-year testing is sufficient.
Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible.