A Question Of Health: Would a special diet help my gout? And what can I do about my bladder stone?

WHAT SHOULD I BE EATING?

WHAT SHOULD I BE EATING?

I suffer from gout. Are some foods, fruit or drinks more likely to increase uric acid in the system? I have been taking one allopurinol (300mg) tablet daily for two months, but I still have some fairly severe attacks. What should I be doing?

Gout is caused by high levels of uric acid in the blood. We all have some uric acid floating around in our bloodstreams, but people who get gout have more than average. Attacks occur when crystals of uric acid precipitate out of the bloodstream and get into the joints. These crystals are tiny, but the pain that they cause can be excruciating. Uric acid is produced by the breakdown of certain foods that contain protein. So it is logical to think that a low protein diet will prevent gout. But in fact the situation is much more complicated. There are a number of factors, including genetic differences, which make some people produce more uric acid than others, even if they eat identical diets. Some drugs can also cause gout, especially diuretics in the thiazide family - the most commonly used one is called bendrofluazide. Even low doses of aspirin can cause an attack of gout, by affecting the kidneys' ability to get rid of uric acid in the urine. Allopurinol blocks the formation of uric acid. If your levels are back to normal, your gout attacks are likely to decrease in number. But if your joints have been permanently damaged by uric acid crystals, your suffering may continue. What should you be eating and drinking? It probably doesn't make much difference what you eat, but how much you eat certainly makes a difference. Reducing your weight, and reducing your calorie intake, is very likely to reduce the number of attacks of gout that you get. Too much alcohol will not make things better.

RIDGES ON THE NAILS

I have recently noticed horizontal ridges across my fingernails. I have always had quite reasonable nails, and I can't think of anything that might have caused the ridges. All of the nails seem to have a similar ridge, about one-third of the way up from the bottom.

These ridges are known as Beau's lines, named after the French doctor who first described them in the medical literature in 1846. They usually mean that something has temporarily interfered with the growth of the nail. A period of serious illness can cause horizontal ridges to appear on the nails. People who have been hospitalised or who have chemotherapy sometimes notice nail ridges a few weeks after they finish their treatment. The ridge represents the time during which nail growth stopped while the body was affected by the illness or chemotherapy. The ridges eventually grow out and the new nail is smooth and shiny. Vertical ridges can also appear on nails. The cause for these is not well understood, but they are not a sign of serious disease.

DO I NEED AN OPERATION?

For a long time I have suffered from urinary problems. The urine sometimes contains a few drops of blood, and sometimes there is blood mixed in with the urine. The blood seems to appear if I walk a long distance. Tests show that I have a stone in the bladder, which is about 3cm across. Is there any alternative to an operation to remove the stone? How urgent is it that the stone be removed?

Bladder stones are relatively uncommon in Western countries, but in some parts of the world they occur quite frequently. They are usually caused by some other condition, such as an enlarged prostate gland, that prevents the bladder from emptying fully. Urine that sits in the bladder allows stones to form. There are several ways of getting stones out of the bladder. The stones can be smashed into little pieces with a variety of devices, and then they can be removed or washed out of the bladder. This is usually done through a cystoscope that is passed into the bladder through the penis. Big stones may need to be removed by an operation. Stones take a long time to form, so it is likely that your problem has been developing over many months or years. There is no great urgency to have the stone removed, but as long as it is there it is likely to give you symptoms and make it more likely that you will develop urine infections.

HAVE YOUR SAY: READERS WRITE

BD from Cheshire discovered that one of her children was born with cataracts:

Your article about cataracts developing early didn't mention the fact that children can be born with them. Our third child was born with cataracts in both eyes. This was spotted and he had an operation to remove them.

LR from London is less than enthusiastic about cataract operations:

They don't tell you everything, do they? I never suspected that the "successful" cataract operations that transformed my myopic universe would leave me with bulging eyes.

JC from Northampton is still suffering from the effects of Osgood-Schlatter disease 30 years after it started:

I think it is misleading to say that the problem disappears when growth stops. I had Osgood-Schlatter disease in my teens, but am left (at 42) with a lump of bone below my right knee.

Send questions and suggestions to A Question of Health, 'The Independent', Independent House, 191 Marsh Wall, London E14 9RS; fax 020-7005 2182; or e-mail health@independent.co.uk. Dr Kavalier regrets that he is unable to respond personally to questions