Man has one kidney and many problems

Q: My husband has various medical issues that make creating a menu almost impossible. Help is needed for recommendations of what to do and not to do.

He only has one kidney, controls his diabetes with diet (so far), has high blood pressure, gout, plantar fasciitis, and a bad knee and back that make walking/running difficult. What is good for one thing is bad for another. HELP. He is the love of my life and I want him around for decades to come.

A: The kidneys clean waste and extra fluids from the body, help control blood pressure, make red blood cells, maintain a proper balance of minerals in the blood, and even help keep bones healthy. They are located just below the rib cage on each side of the spine and partially protected by the rib cage at the back. You don’t indicate why your husband has only one kidney, but essentially there are three main reasons: he was born that way, one was removed because of injury or disease, or he chose to donate one to someone whose kidney(s) had failed. The body is a truly amazing thing; if only one kidney is present, the body adjusts accordingly and that one kidney functions as two normally would. So, whatever the reason, he can live with only one but must, as you are clearly aware, take some precautions.

Dietary choices should be healthy ones. He should eat fruits, vegetables, grains, and low-fat dairy products. His alcohol and caffeine intake should be rather limited, and his sodium (salt) intake should be 2,000 mg or less daily if he already has a diagnosis of hypertension. Consuming a moderate amount of protein is important for proper nutrition but he should avoid a high-protein diet because of the increased stress placed on the one kidney he has.

While he should avoid contact sports such as boxing, wrestling and football, he can exercise in other ways. For example, he might consider aerobic swimming at a local community center, walking, riding a stationary bicycle in your home, and more. In fact, some health centers offer exercise programs done from a chair and sitting position.

I can understand your husband’s diagnosis of gout because his one kidney may not successfully clear uric acid from his body and gout attacks can precipitate kidney stones that can lead to kidney disease. Generally speaking, however, gout can be controlled with oral medication – specific drugs to prevent attacks, and other meds to reduce the pain and discomfort once an attack has begun.

Plantar fasciitis is inflammation of the tissue on the bottom of the foot. It occurs when this already thick band of tissue is over-used or stretched to excess. It is most common in men between the ages of 40 and 70. Common causes for the condition include being a long-distance runner, obesity, sudden weight gain, having either high arches or flat feet and wearing shoes with poor or no arch supports, and having a tight Achilles tendon. Treatment commonly begins with over-the-counter ibuprofen or acetaminophen, stretching exercises, rest, the application of ice, and more. A splint worn while sleeping might be an option. Unfortunately, treatment can take several months before real progress is seen.

Back and knee pain can have causes too numerous to mention, but I would venture a guess that his immobility might contribute to both issues. Before even making any recommendations, I would feel better if your husband had an examination and possibly X-rays either through his primary care physician or an orthopedic specialist to rule out unknown causes. If no condition or abnormality is found, appropriate suggestions for a reduction of pain can be made.

You’ve got a lot on your plate. Begin with an appointment with your husband’s nephrologist and PCP. Request a recommendation to a top dietitian and physical therapist, both of which will have numerous issues to cover. You should accompany him since you’re the menu planner. With strict adherence, your husband just might be able to keep his sugar levels within control, lower his hypertension, control his gout, reduce his level of pain, and remain in your life for decades to come.

Readers who would like related information can order Dr. Gott’s Health Reports “Hypertension”, Gout,” and “Diabetes” by sending a self-addressed, stamped number 10 envelope and a $2 (for each report) US check or money order to Dr. Gott’s Health Reports, PO Box 433, Lakeville, CT 06039. Be sure to mention the title(s) or print an order form from www.AskDrGottMD.com.

Gout is a painful condition

Q: My son is 52 and keeps getting painful gout. He does not drink and eats healthy food. What could be the cause?

A: Gout is an extremely painful form of arthritis that occurs in individuals who have high levels of uric acid in their blood. The body produces uric acid when it breaks down purines, nitrogen compounds that may be end products of the digestion of proteins in our diet. Purines are also in drugs and other substances including caffeine, anchovies, organ meats, asparagus, and more. Normally uric acid dissolves in the blood, passes through the kidneys and is expelled through urination. When the body is unable to use and release purines, crystals build up in a joint and cause inflammation. Men between the ages of 40 and 50 are more likely than are women to be diagnosed with gout; however those women post-menopause are at increased risk almost on a par with men.

Symptoms include very sudden attacks of inflammation, redness and extreme pain that can begin without warning. The most common area on the body for this to occur is in the great toe; however, gout can also occur in other joints such as the knees, hands, wrists, ankles and feet.

The risk of developing gout is increased with excessive alcohol consumption, specific medications to include low-dose aspirin and thiazide diuretics for high blood pressure, hypercholesterolemia, arteriosclerosis, and with a family history of the disorder. Complications occur when an individual has kidney stones because of the possibility of urate crystals collecting in a person’s urinary tract and when the condition is left untreated, or with destruction of the joint the gout has attacked. This is a long-term complication.

Diagnosis can be made through joint fluid being drawn from the affected area that may reveal the buildup of urate crystals, or simple blood drawing; however some individuals may have high lab readings but not experience gout and on the flip side, some people show signs and symptoms of gout but don’t have abnormal uric acid levels in their blood.

Treatments are many. Non-steroidal anti-inflammatory drugs (NSAIDs) can reduce the pain and inflammation of an attack. There are over-the-counter choices or prescription NSAIDs that are more powerful. On the downside, these anti-inflammatories can cause abdominal pain and bleeding. Once symptoms appear, a drug that will reduce pain effectively once an attack has begun, is colchicine. This may also be the maintenance medication of choice in a reduced dose for preventing future attacks. Corticosteroids – either taken orally or via injection into the joint – are generally reserved for those individuals that fail to get relief from NSAIDs or colchicine. There are drugs such as allopurinol and probenecid designed to reduce the amount of uric acid the body produces. In recent years, the anti-hypertensive drug losartin and the lipid lowering drug fenobibrate work in a similar manner as do allopurinol and febuxostat and may be prescribed.

While medication may be necessary for your son to achieve relief, he can make specific lifestyle changes such as drinking two to four liters of fluids daily (the bulk of which should be water), limiting his daily intake of meat, fish and poultry to no more than six ounces daily, and adding low fat dairy products and tofu. Some individuals find their symptoms exacerbate when they consume too much shellfish, so your son might review his intake of shrimp, scallops and other possibilities. Eating a handful of fresh/dried cherries daily and perhaps adding a vitamin C supplement might keep things in check.

Other readers who would like related information can order Dr. Gott’s Health Report “Gout” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to Dr. Gott’s Health Reports, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com

WWII vet with renal failure plagued with gout

DEAR DR. GOTT: I am an 86 year-old WWII vet in very good health. In the early part of last year I developed a bad case of gout for the first time. Several months later I slipped getting out of the shower and fractured my pelvis. I made a very good recovery from the fracture but my gout has persisted to this day. I have edema in both legs. I’m on Lasix 40 mg twice daily and allopurinol 100 mg. Most recently I started wearing compression stockings. My kidneys are functioning at 40% and have been stable for the last four years. PCM, nephrology and cardiology doctors don’t seem concerned but I am very worried since this condition has lasted so long.

I would appreciate your opinion regarding this condition and or any suggestions regarding my affliction. Sign me yours with gratitude.
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Back pain isn’t gout

DEAR DR. GOTT: Does gout ever affect anything other than joints? My brother thinks he has gout in his middle back. Thank you.

DEAR READER: Not to my knowledge. Gout is a complex form of arthritis that attacks joints – primarily those of the great toe. It occurs when urate crystals form in a joint because of high levels of uric acid in the blood. The body naturally produces uric acid during the breakdown of purines, a large group of nitrogen compounds that may be products of protein digestion in the diet, from some drugs and even from caffeine. Those foods high in purines that should be avoided include legumes, organ meats, anchovies, sardines and more. The healthy individual’s uric acid dissolves in the blood, passes to the kidneys and is excreted through urine. When the system fails and the body either produces too much uric acid or the kidneys excrete too little uric acid, [Read more…]

What causes elevated uric acid levels?

DEAR DR. GOTT: You always provide clear information on a variety of question. Thus, mine.

I am an 85-year-old female in relatively good health. I take only levothyroxine and Zocor for medications. I recently had minor surgery and subsequently developed joint and muscle pain in my shoulders, arms, hips, thighs, and lower legs. There was no redness nor fever nor pain in my toes or feet. Blood work showed an elevated uric acid of 7.2.

A few years ago I had polymyalgia. This episode felt just as that did. I was treated for gout – cortisone injection and allopurinol tablets this time. Is there anything else that could cause an elevated uric acid level other than gout?
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Home remedy for gout

DEAR DR. GOTT: I suffer from gout and the joints on my right hand burn like fire. I am taking thyroid and high blood pressure medication but wonder if there is a home remedy for the gout I might add.

DEAR READER: Gout is a somewhat complicated form of arthritis that affects the joints, such as those in the big toes, ankles, wrists, hands and knees. The pain is accompanied by inflammation and redness of the joint(s) involved. The cause for this condition is because of a buildup of uric acid crystals in the blood. The body produces uric acid when it breaks down organic compounds known as purines in the blood, or from specific foods consumed to include organ meats, asparagus, mushrooms and more. In the healthy individual, uric acid will dissolve in the blood, pass through the kidneys and be excreted through urination. When the body produces too much uric acid or the kidneys [Read more…]

Black cherries to the rescue

DEAR DR. GOTT: I started taking allopurinol about a year ago for gout with mixed success. I happened to mention having gout at my local gym about six weeks ago and was totally surprised to hear how many people have had it.

Then four people mentioned getting black cherry concentrate at the local health store at $17.00 for a three month supply. I cannot believe what a difference the cherry concentrate has made. My pain has been completely gone for the last month and I have been able to work out at the gym like I did before the gout started a year ago.

Thank you for the info on gout and keep your great medical column coming.
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Tips for dealing with gout

DEAR DR. GOTT: I just found out that the terrible pain I have been having is gout. Through many hours of research on the Internet, I have found out that I should not eat high-purine foods but should eat low-purine foods. However, I cannot find a list of what is acceptable versus what is not. Can you help? Also, is there a website, book or other resource where I could find menus? Thank you.

DEAR READER: Gout is a form of arthritis that causes a buildup of urate crystals in one or more joints. These crystals develop because of greater-than-normal levels of uric acid in the blood. Uric acid is created during the breakdown of purines. Gout most commonly affects the base of the great toe, but can also appear in other joints such as the feet, ankles, knees, wrists and hands.
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Expensive Colcrys replaces colchicine

DEAR DR. GOTT: You told a reader the injectable form of colchicine is no longer available but the oral tablet is. I beg to differ. I recently attempted to get a renewal of colchicine and was told by the pharmacist that it was no longer available and had been withdrawn from the market. I had to have my doctor write a script for the brand name Colcrys. My health plan, which usually pays for my generic medications, balked, and I had to pay more than $40 for the brand name Colcrys. The generic has been withdrawn from the market, according to my Walgreens pharmacist.

DEAR DR. GOTT: Oral colchicine was taken off the market because there was no way to check for objectionable materials in the formula. It was replaced with Colcrys, an FDA-approved drug, this past December.
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Has colchicine been nixed?

DEAR DR. GOTT: I was in my doctor’s office last week for new prescriptions, and he indicated that colchicine is being pulled from the market. I take it for gout and don’t know what I can use in its place. Do you have any suggestions?

DEAR READER: As you are aware, oral colchicine is prescribed either to prevent attacks of gout brought on by the presence of too much uric acid in the blood or to treat symptoms once they occur. The injectable form has been on the market since the 1950s and has been used for acute gout attacks and as an alternative for the treatment of back pain.
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