Question: Can you give me some information on pseu-do-gout? Why do they call it that? What triggers an attack? Is there any cure or drug to ease the pain? It is very painful.
- M.L.Answer: The term "pseudo-gout" distinguishes the illness from classic gout, the kind that results from piling up of uric-acid crystals in joints. In pseu-do-gout, the same kind of joint pain occurs, but the villain is calcium-pyrophosphate-dihydrate crystals.
In regular gout, the crystals - urates - result from a high concentration of uric acid in the blood. The excess acid eventually crystallizes into needlelike joint deposits, the immediate cause of pain. In pseu-do-gout, it's excess calcium that settles out into painful joint-clogging deposits.
Urates reflect an inability to handle the uric acid debris from normal death and renewal of body cells. Pseudogout might reflect an overactive parathyroid gland, whose hormones are supposed to keep blood calcium in check.
Any gout can take some time to develop to the point of pain. In calcium gout, the most frequent site is the knee. Regular gout might signal its presence with a sharp attack of pain in the great toe, although pain from standard gout can arise in any joint.
An acute attack of either kind of gout can be triggered by trauma, such as an injury or joint stress from a long walk.
Anti-inflammatory drugs such as indomethacin usually bring pseu-do-gout inflammation and pain under control. With regular gout, special drugs are used either to modify the uric acid buildup problem or to prevent pain from acute attacks.
For more details, see my gout report. You can order by writing: Dr. Donohue - No. 13, Box 5539, Riverton, NJ 08077-5539. Enclose $3 and a self-addressed, stamped (52 cents) No. 10 envelope.
Question: I understand there is medicine for use by a young man who has a bad case of hiccups. Is it a prescription drug? What is the name. I know of a young man with such a difficulty.
- Mrs. K.E.
Answer: I trust that you use the term "bad case" advisedly.
There are medicines that can be used to try to interrupt extended hiccups cycles. Chlorpromazine is one. Others are carbamazepine, diazepam and metoclopramide, all prescription drugs.
Has your young friend tried the tricks? One, which I've mentioned here before, involves taking of a spoonful of granulated sugar. Others try sipping ice water or sucking lemon wedges saturated in bitters. Gargling might help.
Remember, though, that some serious medical problems can lie behind extended or chronic hiccups.
Question: My fiance has started smoking a pipe. He likes the smell. I don't mind it myself, but I worry. He says he does not inhale, but I wonder about cancer anyway. What's your opinion? He's only 21 and an athlete.
- D.H.
Answer: Pipe smokers who don't inhale have a lower risk of lung damage than cigarette smokers do. But they are absorbing some nicotine through the mouth linings.
Nicotine, whatever its source, constricts blood vessels, something not advised in an athlete.
Other more direct concerns are of lip cancer and similar mouth, throat and esophagus problems.
Many pipe-smoking former cigarette smokers actually end up inhaling, no matter what they claim.
Question: My son is a scuba diver in Florida. He is 40 and has always been in good health. Recently, tissue around his left elbow became sore and eventually painful to the touch. His doctor referred him to an orthopedic doctor, who drained it. The material contained what he called "Mycobacterium marinum." He is now on antibiotics. Please comment on this diagnosis.
- D.G.C.
Answer: The "marinum" reference tells you this is a germ associated with aquatic activity. Fish tanks can harbor it, and swimmers can pick it up, especially around the Gulf Coast. The germ enters through a tiny break and settles in a joint, such as the elbow.
I cut your longer letter for space. You mention elsewhere rifampin and ethambutol, two antibiotics used for a Mycobacterium marinum infection. As you note, the ethambutol can affect the optic nerve, but that is rare. Besides, the eyes are checked from time to time while the patient is taking it. If need be, the medicine can be stopped, in which case the eyes return to normal. Ethambutol is not a new drug.
Mycobacterium marinum infections often take months to clear up.