DEAR DR. DONOHUE: I’m just an old country woman who needs to know more about gout. I have it at least twice a year, and it’s so painful I can’t put my foot to the floor. Please list the things not to eat so that I can kind of keep it under control. — E.W.
ANSWER: Uric acid crystals that bore their way into joints are the cause of gout. Uric acid is a byproduct of the daily turnover of body cells. As long as blood uric acid stays within a normal range, all is well. When its blood level rises, the uric acid infiltrates joints and causes intense joint pain, swelling, redness and heat.
Gout mostly happens to middle-aged and older men and to women who have gone through menopause. The base of the big toe is often the first joint to suffer an attack. Further attacks can target the heels, ankles, knees, elbows, wrists and fingers.
The definitive proof of gout is finding uric acid crystals in joint fluid. A rise in blood uric acid level is another tip.
The gout diet is not very restrictive. The consumption of red meat and especially organ meat (kidneys, heart, liver, brain and sweetbreads) should be minimized. It’s best to avoid gravies. Seafood, especially anchovies, sardines and shellfish, should be eaten in moderation. Alcohol — beer in particular — can provoke an attack. All vegetables and fruits are permitted, and low-fat dairy products appear to prevent attacks.
Gout medicines are of two varieties: ones for an acute attack and ones for prevention. Indomethacin is for an acute attack, as is colchicine. Zyloprim (allopurinol) and Benemid (probenecid) prevent attacks. Zyloprim decreases uric acid production, and Benemid enhances its excretion by the kidneys.
DEAR DR. DONOHUE: I coach junior-varsity football. In the past three years, I have had three boys have a tooth knocked out. I am trying to prepare if this ever happens again. Can you help? — H.J.
ANSWER: A knocked-out tooth can be saved if quick action is taken. Don’t scrub or rub the tooth. Ligament tissue clings to it, and preserving that tissue is necessary to re-establish its mooring in the tooth socket. Rinse it with tap water. Keep the tooth moist. Reposition in the mouth if that’s possible. If it isn’t, put it in a container with cold milk or sterile saltwater. Transport solutions to preserve teeth are commercially available. One is Save-A-Tooth; keep some vials of it on hand at all games and practices.
Get the injured player to a dentist promptly. Make arrangements with a dentist to be on call at home during all games and in the office during practices.