From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: GOUT
Date: 29 Dec 1998 04:00:36 GMT

In <IeWh2.24887$el4.37807678@c01read02.service.talkway.com> "ANNROSS"
<ANNROSS@ROCKETMAIL.COM> writes:
>
>MY MOTHER HAS BEEN DIAGNOISED WITH GOUT? WHAT CAN SHE DO ABOUT IT? SHE
>HAS HIGH BLOOD PRESURE SO SHE CANNOT TAKE CERTIAN MEDICINES. SHE IS 66
>YRS OLD.
>THANK YOU!



  9 out of 10 gout suffers are men, so I'm always suspicious of this
diagnosis in a woman unless it was made by the time-honored and nearly
foolproof way of sticking a needle into the affected joint, aspirating
the fluid, and having somebody who knows that they are doing look at
the crystals under a polarizing microscope.  If that wasn't done for
your mother, you might consider that the diagnosis is not yet
confirmed.  Suggest you do that first.  See a rhematologist and don't
settle until you get the needle.  With a little Marcaine as a digital
block first (I assume it's in her toe?  If not, say), it's not a very
painful procedure.

                                   Steve Harris, M.D.

Newsgroups: sci.med.pharmacy
Subject: Re: hypoxanthine
From: dyer@spdcc.com (Steve Dyer)
Date: Sun, 15 Apr 2001 06:45:49 GMT

In article <3ad70ad2.894676@news.cwnet.com>,  <wuf@wuf.net> wrote:
   >Can anyone tell me about the pharmacology of hypoxanthine? Is there a
   >web site that will give me information? Dose, effects, drug names,
   >etc?

Unless I'm having a sudden spasm of forgetfulness, hypoxanthine isn't
a drug; it's a biochemical intermediate found in your body during the
metabolism of purines to uric acid (which is thereupon excreted by the
kidneys, or sometimes insufficiently excreted, such as in the case of
gout.)  I believe the pathway is something like adenosine/guanosine -->
adenine/guanine (minus the ribose sugars) --> inosinic acid -->
hypoxanthine --> xanthine --> uric acid.  I might be missing a step
or two.

The big problem with uric acid is that it's scarcely soluble in water
at the pH found in your blood and urine, and if someone has a problem
of making too much uric acid. or their kidneys can't excrete it rapidly
enough (or sometimes both situations at the same time), uric acid
can precipitate out of solution and form crystal deposit in joints,
beneath the skin, or in the kidney (among other places).  When uric acid
crystals collect in joints, when they irritate the tissues and are attacked
by white blood cells--phagocytes, causing inflammation and intense pain,
you get what is called an attack of "acute gouty arthritis".

Personal aside:
     My father has gout, which is usually under control with
  drugs, and he's ordinarily extremely stoic when it comes to pain, but
  there have been two times (in the same hospital actually in
  consecutive years) when he had to discontinue his anti-gout drugs
  before non-electively scheduled, more or less emergency gall-bladder
  and coronary bypass surgery, and days after both surgeries, the worst
  pain he ever experienced both times was the ensuing acute gout attacks
  that occurred like clockwork a day or so after the surgery (and the
  equally-predictable/clockwork medical/nursing staff's reluctance to
  do anything whatsoever to treat it.)  My father finally called my mother
  demanding that she smuggle in one of his "green pills" (indomethacin,
  a potent antiinflammatory that someone might not want to give to someone
  who was just stitched up closed, but as far as dad was concerned,
  he didn't care.  All he wanted or needed was that one green pill.
  My poor mother felt like she was Pablo Escobar when she skulked
  into his room carrying the illicit Rx bottle.)

One drug used to treat the long term manifestations of gout and other
situations in which uric acid levels are excessively high is called
allopurinol. It inhibits the enzyme xanthine oxidase, which catalyzes
the conversion of hypoxanthine to xanthine, and xanthine to uric acid.

Allopurinol first competes with hypoxanthine for the active site on
xanthine oxidase, and is converted in the process to an active metabolite/
drug called alloxanthine or oxipurinol--take your pick.  Unlike allopurinol,
oxipurinol is a non-competitive, suicide inhibitor of the same enzyme,
xanthine oxidase--once the enzyme and oxipurinol meet, it's effectively out
of commission forever, and a new molecule of xanthine oxidase must be
synthesized to take its place.  Thus, instead of an accumulation of
excessively high levels of uric acid in a patient being treated with
allopurinol, you end up with a mixture of hypoxanthine, xanthine and
uric acid in the particular bodily fluid, and each of these (believe it
or not) have solubilities in water that are independent of one another,
and this often allows the three well-disssolved metabolites to be flushed
out as their kidneys intended.


--
Steve Dyer
dyer@ursa-major.spdcc.com

From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: sci.med
Subject: Re: Steve Harris-We cannot reply to you?????
Date: Thu, 28 Mar 2002 12:19:39 -0800
Message-ID: <a7vtqp$27c$1@slb6.atl.mindspring.net>

WILLIAM M. LEITNER wrote in message ...
>
>Dear Steve harris,
>
>Please tell us how we can contact you by e mail concerning the
>gout in a female. We have seen the doctor and he had the female
>take a blood test to determine the uric acid in heer systerm and
>also had a exray to dsee if the wrist had a break in the bone.
>
>We do not expect to get our report from the doctor until
>next week. Meanwhile, we wanted to know more about gout and
>thought that you might be able to help us understand what it is
>and what caused it and how one can cure it.
>
>Can you help us?
>Bill


Not personally.  Newsgroups are the place for this.  I do email only for
people who figure out my correct address.

Serum urates are NOT a good way to diagnose gout.  In real gout sufferers
during an attack, they are quite frequently normal.  This goes along with my
suspicion that you have the wrong diagnosis.  To make the real diagnosis you
need a joint aspiration by a rheumatologist or orthopod (somebody who knows
what they're doing) followed by microscopic examination of the fluid.
Without that, especially in a woman, you have NOTHING.  The only woman I've
ever SEEN with gout was a lady with a bad family history who'd recently been
started on a thiazide blood pressure med. And she had a swollen big toe
joint, not a wrist, and normal serum urates.

So it's pointless to talk about what has caused the disease. You don't yet
have a diagnosis.  Don't be pressured into treatment-- demand a consult with
a rheumatologist, preferably at your nearest medical school.  If your doc
refuses, use the most powerful incantation known in modern medicine.  "Doc,
I'm sorry, but you're fired."

SBH



--
I welcome email from any being clever enough to fix my address. It's open
book.  A prize to the first spambot that passes my Turing test.

From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: sci.med
Subject: Re: What is Psuedo Gout?
Date: Tue, 9 Apr 2002 16:29:39 -0600
Message-ID: <a8vq0k$3d9$1@slb3.atl.mindspring.net>

"WILLIAM M. LEITNER" <bilwi@aztec.asu.edu> wrote in message
news:a8v7a2$h51$1@news.asu.edu...
>
> My wife has been dignosed with pseudo gout.
> Will you please tell me what caused this condition?
> And what is pseudo gout?
> My wife's wrist is swollen and that was the dignoseis
> Bill


This is the lady I said was unlikely to have honest-to-god gout, right?  So
did somebody finally put a needle into the joint?

At least we saved her from taking allopurinol and anti-uric acid stuff like
that. The bad news is that treatment for CPDD aka pseudogout isn't very
specific.  Mostly stomach acid blockers and Vioxx or Celebrex is your best
bet on long term therapy. Make sure she gets a multivit and vitamin E. You
can go and get IV colchicine if things get bad.  Oral colchicine is probably
more bother than it's worth.

SBH