Dear Doctor: Can you please explain what gout is and how it’s treated? Our father is 81 years old and was just told that he has gout. His doctor says it could be because he takes water pills for swelling due to congestive heart failure. Does that make sense?

Dear Reader: Gout is a type of arthritis that can occur due to the presence of high levels of uric acid, a metabolic waste product, within the body. The kidneys eliminate uric acid via the urine, and some is excreted via the gut. But sometimes the accumulation of uric acid in the blood can exceed the amount that is excreted. This can lead to the buildup of tiny needle-shaped deposits, known as urate crystals, in and around the joints.

The condition causes periodic episodes of swelling and pain, which can be intense. Symptoms of someone’s first gout attack typically begin at the base of the big toe. However, in subsequent flare-ups, gout can also affect the other joints of the lower leg, including in the foot, ankle and knee. Although gout can affect either sex, it’s three times more common in men than in women. For men, the onset typically begins in middle age, often around age 40 and onward. Women become more susceptible to developing gout during and after menopause.

Diagnosis begins with a physical exam, and includes tests to measure blood levels of uric acid. The patient is asked about the location and severity of their pain, when the attacks first began and how quickly they arise. This last bit of information is important because one of the hallmarks of gout flares is their sudden onset, usually at night or in the early morning. Many patients report pain so severe that it wakes them from sleep. The affected joints are often swollen, sensitive to pressure and warm to the touch. Gout flares tend to subside over the course of a week or two. Some people have frequent flares, while others can go months, or even several years, between attacks.

A diet high in meat, fish, seafood, alcohol and sugary drinks can contribute to elevated blood levels of uric acid. Having diabetes or taking certain medications, including the diuretics that your dad is taking to manage his edema, or swelling, can impede the removal of uric acid. So can being overweight. A family history of gout is also considered to be a risk factor for developing the condition.

Treatment focuses on managing pain and swelling during an attack, as well as adopting preventive behaviors. These include staying hydrated, avoiding or limiting the use of alcohol, cutting back on meat, poultry and fish and maintaining a healthy body weight. If someone needs to lose weight, it’s important to do so gradually. Crash diets can have the effect of temporarily increasing levels of uric acid. In your father’s case, he should let his cardiologist know he has developed gout. It’s possible that a different type of diuretic may be helpful.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: Why are people making a big deal out of the fact that you can lose your sense of smell and taste when you get sick with COVID-19? The same thing happens to me when I’ve got a plain old cold.

Dear Reader: Many of us who have slogged through the unpleasant symptoms of a cold or the flu know that losing your sense of smell, and often a large portion of your sense of taste, is a common part of the experience. The same has proven to be true with COVID-19. However, it turns out that this loss of the sense of smell, known as anosmia, occurs for two very different reasons.

Let’s start with a cold and the flu. Our immune systems fight these infections on multiple fronts, including the one-two punch of mucus production and inflammation. This combination does an excellent job of blocking our sinuses. Since the sense of taste is closely linked to the sense of smell, both take a steep dive during the plugged-up phase of an illness. With specialized nerve endings in the nasal passages unable to send a full range of information to the brain, the subtleties of taste are gone. What we’re left with are the broad strokes of bold flavors. That’s why, when we’re fighting a cold or the flu, the sweetness of hot tea with honey or the saltiness of chicken soup tastes particularly good.

When it comes to COVID-19, researchers have recently uncovered the surprising reason for anosmia as one of the earliest symptoms of infection. Rather than congestion, as with a cold or the flu, the loss of smell in people with COVID-19 occurs due to how the virus affects the nervous system. According to a study published by researchers at Harvard University earlier this summer, SARS-CoV-2, the virus that causes COVID-19, attacks certain cells whose job is to support the olfactory sensory neurons. These are the specialized nerve cells that detect the chemical compounds that make up a scent, known as odorants, and transmit that information to the brain. The brain then decodes the electrical impulses, which allows us to experience them as scent. By damaging the support cells, the virus prevents the olfactory sensory neurons from responding to the molecules that make up different types of scents. The good news is that for most patients, recovery from COVID-19 includes a return of their sense of smell.

As we’ve mentioned here before, researchers are still in the earliest stages of learning about the novel coronavirus and COVID-19. That makes each new bit of information important. As cases began to mount, it became clear that only about half of contagious people presented with a fever as an early symptom. At the same time, it emerged that a loss of the sense of smell was one of the first symptoms of infection. Since early intervention gives people who become ill with COVID-19 a better chance of recovery, this has been a significant finding. Thus, the widespread news stories and discussions that you have noticed.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: What on earth is a “gutoscopy”? We saw it on the news -- something about a pill that goes in one end and comes out the other, but it sounded more like science fiction than anything real.

Dear Reader: Your question brings us to the brave new world of what are sometimes referred to as “smart pills.” These are tiny devices, small enough to be swallowed, that perform a range of functions as they move along the gastrointestinal tract. This can include the precision delivery of medication, the collection of different types of data, and keeping track of whether or not someone is taking a prescription as needed.

Certain types of smart pills are equipped with biosensors, pH and chemical sensors, or imaging capabilities. Classified as ingestible sensors, they can be used to collect information such as pressure readings, pH and temperature data. The data they gather can shed light on the workings of the stomach, small bowel and colon. Rather than an invasive procedure that requires surgery or an instrument threaded through a catheter, the patient swallows a capsule that contains the miniature sensor. The device then transmits its findings to a computer.

Some types of smart pills are engineered to collect samples from inside the body for study and analysis. That’s the case with the “gutoscopy” device you’re referring to in your question. Developed several years ago by researchers at Purdue University, the team published a paper about its findings earlier this year. Their goal was to devise a noninvasive method to learn more about the billions of microscopic organisms that live within the human gut.

Research continues to link the workings of the gut microbiome to an ever-expanding array of biological functions and health conditions. This includes obesity, diabetes, mood, digestive disorders, cardiovascular health and certain cancers. The composition of the gut microbiome has also been linked to various neurological diseases, including Parkinson’s disease, multiple sclerosis, autism spectrum disorder and Alzheimer’s disease.

The “gutoscopy” capsule, which is still in the research phase, is made of nontoxic 3D-printed resin. It’s formulated to dissolve at a specific pH within the gut. This allows the release of a “thirsty” gel, similar to that used in moisture-absorbing pads and diapers. The hydrogel collects gut bacteria from the fluid of the intestine. The capsule is designed to travel the length of the bowel, carried along by the natural wavelike contractions of the digestive process. It collects samples as it goes, until a change in pressure forces the capsule to close. The device passes from the body in a bowel movement. Researchers can then open the capsule, collect the gel and analyze the array of gut flora that it contains.

Unlike existing diagnostic tests, such as a colonoscopy or an endoscopy, this new capsule can travel the entire length of the gut, and it wouldn’t have to be administered in a clinical setting. The goal is to learn more about the diversity of microorganisms living within the gut. That information can help researchers better understand disease processes, and craft medications and therapies.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)