Eight years ago I developed a small swelling on my middle toe, which was later diagnosed as gout. I have been prescribed allopurinol (100mg per day) but it has not helped. I’m a 90 year old man and don’t drink or smoke, but wearing shoes is uncomfortable now. Can you help?
Name and address provided.
Gout is a form of arthritis caused by the buildup of uric acid crystals in the soft tissues and joints. The big toe is the joint most commonly affected, but it can occur in the feet, hands, wrists, elbows, or knees, making them swollen and painful.
Uric acid is a breakdown product of purines and pyrimidines, both of which are building blocks of nucleic acids, compounds found in all living cells. Purines are also found in certain foods and drinks, such as alcohol, high-sugar fruit juices, seafood and liver. Therefore, gout has a reputation as a condition associated with excessive indulgence.
However, you are not drinking and you are in reasonable health. In fact, diet has little to do with the condition for many people; it’s just that the normal mechanisms for ridding the body of this waste product are inadequate, and age, as well as genetics, play an important role.
Gout is a form of arthritis caused by the build-up of uric acid crystals in the soft tissues and joints
If you have an acute attack, prompt treatment with an anti-inflammatory will help – usually corticosteroids or non-steroidal anti-inflammatory drugs (NSAIDs) are prescribed. Another option is colchicine (from the fall crocus).
In the longer term, the focus should be on lowering uric acid levels in the body to prevent other potential complications, such as acute inflammatory arthritis (which causes severe and excruciating pain), kidney stones, and other damage.
For this reason, patients are usually prescribed allopurinol (which you are taking). This works by improving the body’s metabolism of purines and pyrimidines.
However, the process is gradual and it can take many months to reach normal uric acid levels, so it may not be surprising that you haven’t seen an improvement after four months.
The usual starting dose is 100 mg per day. However, if this is not effective (this can be determined by blood tests to check uric acid levels), you may be prescribed a 300 mg tablet.
Let me reassure you that you are on the right drug that, as your doctor rightly says, will take you for life.
In addition, by lowering uric acid levels, allopurinol will result in a gradual disappearance of the swelling on your toe (called a tophus), making wearing shoes uncomfortable.
I have a hard lump under the skin on my back between my shoulder blades. I know it’s not cancer and I don’t want to go to my heavily pressured GP, but it’s bothering me. What is it?
Patricia Rant, Norwich.
I’m sorry to hear that the lump on your back is upsetting you.
As you rightly say, this is not a life-threatening problem, but in my opinion it requires formal treatment, even if that is a minor surgical procedure.
Benign skin lumps fall into three categories: epidermoid cysts (which contain keratin, the protein that makes up hair), pilar cysts (which also contain keratin and arise from hair follicles), and sebaceous cysts. I suspect you have this third type.
Sebaceous cysts can range in size from a few millimeters to several centimeters and have a small pore inside them. This pore normally releases sebum, a waxy, oily material, but when it becomes clogged, a painless dome-like lump develops.
The only effective treatment is surgical removal of the cyst capsule under local anaesthetic. It must be possible for your GP to refer you for this procedure.
There is no reason to stop treatment just because times are difficult in the NHS at the moment.
Write to Dr. Scurr on Good Health, Daily Mail, 2 Derry Street, London W8 5TT or email drmartin@dailymail. co.uk — provide your contact details. dr. Scurr cannot enter into personal correspondence. Answers should be taken in a general context and always consult your own GP if you have health problems.
My duties as a father started at 6 a.m., I woke up two boys before driving to the operating room – usually with a home visit en route – and ended with bedtime stories or a check-off when I saw that no progress was being made with homework at around 8pm.
On Saturday, after my morning in the operating room, we met in a cheerful Italian cafe. My son, who is now an anesthetist, recently took his nine-year-old son to the same spot for Saturday lunch after a long morning helping clear waiting lists.
But my part-time role as a father who works as a GP is not like how things are now, as I recalled when I recently met a cousin who is also a GP. She has a two-year-old, works three full days in her practice, and is about to take another half day at an emergency room drop-in center.
Our conversation was about how to be an effective parent while being pressured by three 12-hour days and facing endless demands to increase her practice days.
This is a major problem in general practice and should be taken into account in future staff planning. I hope the new health minister reads this and decides not to pressure doctors to work more hours and achieve even more goals. Who else would want to train to become a general practitioner?
My part-time role as a father who works as a GP is nothing like how things are now, as I recalled when I recently met a cousin who is also a GP
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