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Drinking and eating rich food to excess is associated with gout
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Ask The Experts
Carmel Thomason21/ 7/2008
I've been diagnosed with gout. Someone told me its referred to as rich man's disease, the disease of kings, why is that?
Nurse Gillian Fox, health care manager for Acumen Medical Services and health advisor to Medi-Lab.
In Roman and Regency times gout was associated with excess – increased weight, alcohol, high meat intake and you saw a typical pictures of people with a bandaged foot. Today we see increased incidence of gout again associated with weight, alcohol and age. Gout may affect any joint but is most common in the great toe joint where it causes severe stabbing pain, tenderness and swelling.
Gout is a defective metabolism of uric acid in the blood, a component of the urine. It is derived from the breakdown of proteins about one third from external proteins found in foods such as meat and shellfish, while the remainder comes from cell breakdown and is excreted in urine and faeces. Because of this foods high in protein can exacerbate gout.
If the level of urate is too high, it can form tiny crystals that collect in your tissues, particularly in and around your joints. This is what causes the swelling and pain. These crystals form at cooler temperatures which is why gout is more common in your fingers or toes.
If untreated attacks can last for seven to 10 days. These crystals in the joints can lead to inflammatory arthritis and can cause nodules over the fingers and joints and also in the ear. They can also give rise to renal stones in the kidney.
High levels of uric acid in the blood can be caused by factors such as changes in diet, alcohol, trauma, infections and dehydration. The drinking of sugary fizzy drinks has also been associated with gout. It is more common in men and women past the menopause. However, not everybody with high levels of urate gets gout and some people get gout but don't have high levels of urate. It's not known why some people develop gout and others don't.
Diagnosis can be made by a blood test while treatment is by lifestyle management and medication which helps prevent further attacks.
For more advice or concerns relating to gout contact your GP or call Gillian on 0161 7721 200.
I keep hearing people talk about the placebo effect of medicine but what does it mean?
Dr Neel Halder, has over seven years' experience as a psychiatrist, and is a member of the Royal College of Psychiatry.
A placebo is a pharmacologically inert substance; a dummy pill. It is used widely in research to see if a new drug is effective. Volunteers are divided up; some to take the new pill, and some to take an identical pill with nothing in it. Researchers don't tell them which is which. You wouldn't expect those taking the dummy pill to get better, but many do. Interestingly, some even suffer side effects from dummy pills; this is known as the “nocebo effect”.
Placebos are thought to work by a number of ways. One is releasing dopamine, the brain's feel good hormone and natural painkiller. They also work by raising expectations. Volunteers who tasted two wines rated the more expensive one as better tasting, when in fact they were both the same. Brain scans reveal increased activation of the pleasure centres when sipping expensive wine compared to the cheap one.
This is replicated when taking medication too. In one American study, painful electric shocks were given to about 80 volunteers. They were then offered two painkillers, one costing $2.50, and one for 10 cents. The result was that pain relief was much stronger in people who took the more expensive drug. In actual fact, there were no painkillers at all, they were all placebos! Price, size, colour (red pills reported to be better than white), and the way you convey the message all play their part.
So optimists and positive thinking can make you better. The power of the mind should never be under-estimated.
I have lobar pneumonia – how long will I feel ill for?
DR Jeremy Tankel has been a GP for 29 years. He works in Salford and is married with four children.
There are two types of pneumonia. Bronchopneumonia and the one I want to talk about today which is lobar pneumonia.
There are essentially five lobes or parts of the lung. Two on the left and three on the right. The tissue of one of the lobes gets infected and eventually takes on the colour and almost the consistency of liver.
The symptoms are cough, some spit which might be blood stained, a temperature, hot and cold shivers, sweating especially at night, often pain breathing in felt on the chest wall, headaches, muscle pains, no appetite and feelings of being very unwell. You may well feel breathless and some people will be breathing faster than normal. If severe then confusion can occur. You will of course need to see your doctor if you think you have pneumonia.
When the doctor listens to your chest it will sound abnormal in the infected area. A chest x-ray will prove the diagnosis. Most causes are bacterial and even if not most doctors will still think it is a good idea to prescribe antibiotics for at least a week. If you are very unwell you may need to be admitted to hospital. Most can be treated at home. Drink plenty, use painkillers for the aches and pains, and rest. If you smoke – don't!
About one in every 100 adults will get this every year and up to one per cent of sufferers will die so it needs to be taken seriously. The infection eventually settles and the lung lobe returns to normal over some weeks. You usually need a check x-ray just to make sure that there is no underlying cause.
Although the young and fit get better quicker, most will take three months before they feel virtually back to normal. Even then 50 percent of people will still have some fatigue, a third a cough and a quarter some residual spit. Depending on the job you will need to take about one month off work. Listen to your body and don't rush things.
My girlfriend keeps complaining about my smelly feet but I don't know what to do about it, it's not as if I don't wash. What else can I do?
Dr Paul Griffiths, Dermatologist at Blemish Clinic, Middleton
Feet have a habit of becoming malodorous from time to time. If you think about it, they spend their lives wrapped up in the dark and drippily damp inside our often non-breathable footwear.
Athlete's foot tends to begin in the spaces between the toes, often the smaller toes. The skin here gets boggy and eventually breaks down, with whiffy results. The condition is caused by fungal infection, the fungus loving the dark, moist environment. It may not be a problem to some people, who have the problem all their lives. To treat the infection, hygiene is important with careful washing and drying (maybe with a hairdryer) as well as frequent sock changes.
Shoes can be treated with an anti-fungal dusting powder and effective anti-fungal creams (such as Lamisil tm) are available over the counter from your pharmacist. If the infection is severe or spreads to involve the nails, oral preparations are available from your GP, though these may need to be taken for weeks.
Policeman's or Houseman's foot (pitting keratolysis) tends to affect people who spend a lot of time on their feet (as the name suggests). Small pits in the skin develop in the skin of the ball of the foot and these stink because of the bacterial infection in them (corynebacterium minutissimum). Soaking the feet with potassium permanganate solution or using a topical antibiotic may help, though a course of antibiotics for six weeks may be needed.
The moral – let your feet breathe and see the light whilst they can.
For an appointment with Dr Griffiths call 08000852309 or visit
www.blemishclinic.co.uk.
If you've got a question for one of our experts write to them c/o Carmel Thomason, Features, Manchester Evening News, 1 Scott Place, Manchester, M3 3RN.
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