Medical matters:Dont' you love the feeling of waking up on the first morning of a week off?
There's nothing better than the hazy realisation that the usual work routine is suspended, with a different pace of life beckoning.
While enjoying just such a moment recently, I became aware of a simultaneous throbbing in my left big toe. As I moved, the pain intensified; friction from the bed clothes produced a similar effect. By now I was more awake than I wanted to be.
A quick examination of the toe revealed an extremely tender joint which was hot and shiny. It had all the appearance of gout. But the thought was immediately challenged by a sleepy list of prejudices, that, had I been more awake, I would like to think would not have emerged from my subconscious: gout is a disease of port-imbibing, rich food-guzzling older men. It couldn't possibly be my diagnosis.
But it was, and I was faced with a mental image of a cartoon featuring an obese gentleman resting his throbbing foot on a stool. It is an image of a man who likes his claret and is over-familiar with rich foods, such as liver, kidney and sweetbread.
In fact, gout affects teetotallers and those with normal dietary habits. But lifestyle factors have a role to play: rising levels of obesity may be one of the reasons for reports that it is becoming a more common diagnosis.
Gout is certainly more common in older people and in men; the joint disorder affects almost 5 per cent of men, with a prevalence of 50 out of 1,000 men aged 65 to 74.
The landmark US health professionals' study that followed some 47,000 men for 12 years found a higher incidence of gout in those who were obese and had a higher alcohol intake.
Interestingly, it was the high-intake beer drinker rather than the wine buff who fared worst. Consuming dairy products actually reduced the chances of developing gout.
A typical history of gout is one of a rapid onset of pain which reaches its maximum severity over six to 12 hours. The joint swells up, becoming red and extremely tender.
The most common site for acute gout is the main joint in the big toe. This classic presentation has been recognised since antiquity. It was given the name podagra by the Greeks, literally meaning "foot catch".
Gout's nomenclature is linked to the French "goutte" and the Latin "gutta", "a drop of fluid". The term seems to have emerged from the humour theory of disease, where symptoms were believed to be the "drop by drop" distillation of "bad humour" in the diseased joint.
Hippocratic medical thinking was based on health being an equilibrium, with illness representing an upset in the delicate balance of the humours.
As I can testify from first-hand experience, the pain of gout is intense and severe. It feels as if your toe has been placed in an ever-tightening vice. The Gout, a 1799 painting by James Gillray, with its image of a crazed Tasmanian devil sinking its fangs into a swollen and red big toe, captures the effect rather well.
Apart from the big toe, other commonly-affected joints include the ankle, other foot joints, knee, wrist and fingers.
Gout is the direct result of the deposition of urate crystals within the affected joint, where they stimulate an inflammatory response. The fact that it affects joints at the extremities may be linked with the finding that urate is more likely to crystallise in cooler parts of the body. Crystal deposition occurs when the blood becomes saturated with urate, which is produced by the metabolism of purine amino acids.
Interestingly, the latest analysis of the health professionals' study, published earlier this month in the British Medical Journal, points to a link between sugary drinks and gout. It found that the consumption of soft drinks sweetened with fructose is strongly associated with an increased risk of gout in men. It also emerged that fruit juices and fructose-rich fruits, such as apples and oranges, increased the chance of an acute attack.
All of which begins to explain why part of my week off was blighted by a throbbing toe.
I am in the process of shedding my winter blubber and have significantly increased my intake of fruit and fruit juice in the last few weeks.
So the disturbing image of following in the gouty footsteps of less-than-desirable role models such as King Henry VIII and King George IV can now be edited from my mind.
Dr Houston is pleased to hear from readers by email at mhouston@irish-times.ie, but regrets he is unable to reply to individual medical queries.