Q & A

Sydney Morning Herald

Thursday August 25, 2005

Dr Linda Calabresi Dr Calabresi is a practising Sydney GP and medical editor of Medical Observer. Email your questions to linda.calabresi@medobs.com.au.

I have had an ache in the joint at the base of my right big toe for ages. Mostly when I walk. I've been told it could be gout. Is this likely and is there anything I can do about it?

While gout does often affect this joint in particular it is unlikely, from the symptoms you describe, that gout is the cause of your problems. Gout occurs where there is a build up of uric acid in the bloodstream and tissues, which can then come out of solution and form crystals. These crystals are then deposited in various tissues classically in the joint of the big toe. However, when this occurs you usually get an acutely red and swollen joint, extremely sensitive to touch.

The symptoms you describe sound less intense and more chronic. Your diagnosis is more likely to be along the lines of arthritis, a bunion or even a stress fracture. It would be worthwhile getting it checked by a doctor.

About two months ago, I noticed a little dimple at the bottom of a fingernail. Since then the problem has spread to other nails and I now have horizontal bars of dimply depressions with some white spots growing up in all my nails.

From your symptoms - pitted nails, with transverse lines and white spots, you could have psoriasis. Usually, if the nails are affected by psoriasis you have other manifestations of the disease, such as skin rash. But in about one in 20 people, the nail changes are the only sign that you have psoriasis. You really need to go to a doctor to be sure of the diagnosis as your nail changes could also be caused by a fungal infection or by a general medical condition of which you are unaware

I have heard that taking the pill increases my chance of breast cancer? Is this true? Should I be having checks? I am 22.

This is quite a controversial area of medicine, with different studies showing different results. However, the consensus of opinion at present suggests there is a very slight increased risk of breast cancer while on the combined (meaning oestrogen and progesterone) oral contraceptive pill. It exists only while you are on it - meaning a 60-year-old woman is not more likely to get breast cancer as a result of taking these pills in her 20s and 30s. Despite the recent spate of high-profile cases, which would have you think that young people are now more likely to get breast cancer, the reality is that breast cancer before the age of 40 remains rare and getting it in your 20s is even more so, even if you are on the pill. The most significant risk factors for getting breast cancer remain increasing age and a strong family history.

As for having regular breast checks this is generally not recommended before the age of 40 mainly because of the rarity of breast cancer in this age group but also because mammograms are less reliable when the breast tissue is denser, which is the case in younger women.

© 2005 Sydney Morning Herald

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