Your HEALTH
Got a medical problem or need health advice? Ask GP Dr Philippa Kaye
Q
I thought gout was a condition from the times of Henry VIII, but our local GP says that my husband has it in his big toe. He has been given some medication, but isn’t gout something that only affects people who eat a lot of meat and drink port?
A
Gout is a type of arthritis, which can be extremely painful and causes inflammation in the joints. It affects about one in 100 people, and is more common in men. It is due to high levels of uric acid in the blood, which can crystallise and collect in a joint, leading to the attack of gout. It tends to cause severe pain in one joint, most commonly the base of the big toe, which may swell up and look red.
We all have uric acid in the body but levels may become higher if you drink more alcohol (probably where the idea of port comes from!), eat certain foods, such as sardines and mussels, or if you are on particular medications, such as diuretics. Having high blood pressure, diabetes, high lipids in the blood, kidney disease or being obese increases your risk of developing gout. It also runs in families.
Treatment involves keeping your foot up, using ice packs to reduce pain and swelling, and taking anti-inflammatory painkillers or an alternative medication called colchicine. If your husband gets regular attacks (more than two per year) or has joint damage due to gout, then a medication called allopurinol can be used to try to prevent attacks.
Q
I’ve heard that testosterone and HRT might prevent dementia. My mum had dementia and I’m terrified of getting it. I’m in my 40s and still have periods, should I ask the GP for it now?
A
Although it is often thought of as a male hormone, females also need testosterone as it has lots of roles in the body, such as affecting energy levels, your musculoskeletal system, your metabolism and your libido, or sex drive. Some women who are taking hormone replacement therapy (HRT) for perimenopausal or menopausal symptoms are offered testosterone too.
The guidance currently suggests that testosterone can be offered for low libido, when it hasn’t improved despite other treatments such as HRT. Women who take HRT often notice that it helps with symptoms such as brain fog and fatigue, and gives them their ‘oomph’ back.
If you are in your 40s and having periods, you can still have HRT, which may include testosterone, for symptoms that can range from hot flushes to depression. However, the guidance currently is not that it should be used as a preventative treatment for conditions such as dementia. We need more research, into the menopause, HRT and testosterone!
Q
I’ve been extremely tired recently and my GP says that my blood tests show low thyroid function, but one number is high and another is low. This may sound like a simple question, but what does that mean?
A
It’s not a simple question, in fact, it’s really important that you always ask if you don’t understand something that your doctor has said.
The thyroid is a gland found in your neck, which is involved in the production of the hormone thyroxine, and has multiple roles in the body, including controlling your metabolism. The brain produces a hormone called thyroid stimulating hormone (TSH), which makes the thyroid gland produce thyroxine. If the thyroid gland isn’t functioning properly and the levels of thyroxine are low, the brain will produce higher and higher levels of TSH to try and stimulate the thyroid gland to produce thyroxine. So it may be that your blood test results show a high level of thyroid-stimulating hormone and a low level of thyroxine. This combination of results would suggest hypothyroidism, or an underactive thyroid, and you may need oral medication. Your doctor will request blood tests to check that the levels have normalised and, once they do, the levels will generally be checked annually, although more frequently if you need a dosage change.