DEAR DR. DONOHUE: Recently I went out to a dinner that began at 6:15 p.m. By 9:15 p.m., I knew something was wrong. I had an uncomfortable ache in the pit of my stomach, followed by five or six episodes of horrible vomiting. Does food poisoning start this fast? – N.N.

ANSWER: There are so many germs and chemicals that cause food poisoning that it would take the entire space of your newspaper to cover all of them. Each behaves a bit differently, and each has different outcomes.

More than 76 million cases of food poisoning occur yearly in North America. Of that number, 300,00 must be hospitalized, and about 5,000 people die.

Food poisoning that begins as quickly as yours is usually due to a noxious product, a toxin (poison), produced by bacteria in the food. Meats, mayonnaise and cream pastries are foods most often implicated in this type of food poisoning. The germ usually responsible is the staph bacterium. You describe a classic episode. It is often gone within 24 hours.

When sickness begins eight to 16 hours after a meal, common symptoms are crampy pain and watery diarrhea. Undercooked meat and poultry are the foods usually involved. This kind of poisoning last about one day.

Symptoms that appear 12 to 72 hours after eating tainted food are severe cramps and profuse diarrhea. The infamous E. coli germ is often the culprit. This sort of food poisoning demands medical attention.

For most food poisoning, sipping liquids that contain some sugar and a bit of salt keeps people from becoming dehydrated, a common consequence of food poisoning. If the temperature rises to 101 F (38.3 C), if diarrhea is bloody, if the pain cannot be tolerated or if there are any indications that the nervous system is involved — such as double vision — people should get to an emergency department. These last symptoms are an indication of botulism, the most deadly kind of food poisoning.

DEAR DR. DONOHUE: I have had gout for several years. I take a daily dose of colchicine and rarely have an attack. I do, however, have bumps that stick out from my fingers. The doctor says they are due to gout. He hasn’t suggested anything to get rid of them. Is there a medicine for that? – C.R.

ANSWER: Those bumps are tophi, and they can be found in many body sites, most frequently around joints.

Gout is due to an excessive amount of uric acid. The uric acid diffuses into joints and forms needle-sharp crystals that produce the pain of a gout attack.

The same uric acid crystals can form mounds under the skin — tophi. They are firm, slightly yellow and sometimes exude a chalky material.

Ask your doctor if you can take Zyloprim (allopurinol). It stops the production of uric acid. Colchicine controls the infiltration of uric acid into joints, but it does not reduce the body’s pool of uric acid.

If your doctor agrees that Zyloprim has a place in your program, don’t become impatient when the tophi do not disappear overnight. It can take a year or more for them to regress.

DEAR DR. DONOHUE: My 83-year-old aunt died suddenly. We were quite surprised because she was active and appeared healthy.

My cousin told me she had digestive angina. I have never heard of such a thing, and my cousin was not clear on the details. Can you fill me in on what this is? – W.B.

ANSWER: Your aunt died due to an interruption of blood flow to a part of her intestine. It is a situation similar to the chest pain that comes on when there is a deficient supply of blood to the heart muscle, so this digestive tract condition is sometimes called intestinal angina. Its true medical name is mesenteric ischemia — “ischemia” borrowed from the Greek and meaning a deficit of blood. This is a most serious illness. Emergency surgery to restore blood flow is sometimes successful, but more often the affected portion of intestine becomes gangrenous, and hordes of bacteria escape into the abdominal cavity and into the bloodstream. Death is a common outcome.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.