The Unhappy Me thread

[kladner]

Originally Posted by xilman

.......
Consensus: severe gout. Treatment is to swallow lots of codeine and naproxen for several days, lay off red {wine,meat} and cheese, and not to walk around much until the pain subsides.

Oh well. It all adds interest to an otherwise largely tedious existence.

An aunt of mine told of a Grandfather, or Great Uncle who had gout in a foot. He rarely left his chair, with the foot propped up. He had a stick to hit anyone who threatened his gouty toe. His beard and mustache had grown uncut for years. Of particular delight to us kids was the part about his nose hairs having grown out, and having merged with his mustache.

EDIT: I had the possibly false impression that there were specific medications for uric acid build up.

[Primeinator]

Originally Posted by kladner

EDIT: I had the possibly false impression that there were specific medications for uric acid build up.

There are several drugs that can help with uric acid generation in the body. Perhaps the most "benign" of these are a class called xanthine oxidase inhibitors. One such example is a drug called allopurinol. The drug works by inhibiting the enzyme xanthine oxidase which is responsible for several important reactions in the body. The first is to oxidize hypoxanthine to xanthine. Xanthine then will move down one of three pathways; however, the most important physiologically is the subsequent oxidation to yield uric acid. Inhibition of this enzyme creates buildup of the substrates in the reaction (hypoxanthine and xanthine) though it is important to note this drug exhibits competitive inhibition in its pharmacokinetics. The buildup of these substrates has the added effect of inhibiting the pathway responsible for generating more substrates (the purine catabolism pathway). This works because the accumulated xanthine and hypoxanthine are broken down to adenosine and guanosine (purine bases in DNA). Even more benefit is provided by the initial breakdown of allopurinol into another compound that also exhibits inhibition of xanthine oxidase.

The drug is NOT completely benign and some recommend genetic testing of a particular component of the major histocompatibility complex prior to its administration as a rare but severe side is Stevens-Johnson syndrome (a potentially life threatening skin reaction). SJS from this drug is more common in some Asian populations compared to those of European descent. Allopurinol is also not suitable for someone with severe kidney disease (or requires careful dose adjustments). Another downside is that allopurinol takes a while to begin working. There is some debate as to whether or not giving allopurinol during an acute attack may exacerbate the patient's condition; however, most research now seems to indicate this is not the case (but I will admit I haven't read a large published study).

Naproxen and other NSAIDs exhibit more complicated pharmacology but work to reduce the inflammatory response of uric acid in the joint space thereby reducing pain. Combined with narcotics, they are much more effective in the short term at reducing symptoms.

[kladner]

@ Primeinator:
Thank you very much for the clear and informative post. The name "allopurinol" certainly rings a mental bell from my youthful employment in a hospital.

[Primeinator]

Originally Posted by kladner

@ Primeinator:
Thank you very much for the clear and informative post. The name "allopurinol" certainly rings a mental bell from my youthful employment in a hospital.

You are very welcome. I am no help when it comes to the mathematics on this forum as much of it is above my pay grade . My knowledge base is much more on the medical and biological side of things!

[xilman]

Originally Posted by Primeinator

This is a somewhat unusual presentation for gout (not that I don't believe their diagnosis especially in the setting of elevated uric acid in the serum). Did they entertain the idea of Doppler ultrasound? Has color returned and swelling gone down? How is the pain? Are xanthine oxidase inhibitors or colchicine in your future?

The foot is now very nearly back to normal in every respect. The medic also noted the unusual presentation, not least because it's uncommon in the 5th metatarsal at all, let alone along the full length as well as at both joints. A synovial fluid extraction was mooted but the diagnosis was sufficiently clear by then that it was thought unnecessary to inflict further pain and, of course, all invasive procedures carry risk of causing further damage.

As noted in subsequent posts, those drugs have significant side effects so there are no plans to use them yet. Dietary control and palliative care are prescribed, the latter being NSAIDs, codeine and resting the foot in a raised position.

[only_human]

Originally Posted by henryzz

I would never have considered that lorry was a word only used in the UK not the USA. You need to stop losing words from our language.

We did not lose this word. You coined the word all on your own:

lorry (n.) - Online Etymology Dictionary
www.etymonline.com › term=lorry
Online Etymology Dictionary. "a truck; a long, flat wagon," 1838, British railroad word, probably from verb lurry "to pull, tug" (1570s), of uncertain origin. Meaning "large motor vehicle for carrying goods" is first attested 1911.

[xilman]

Originally Posted by only_human

We did not lose this word. You coined the word all on your own:

The OED concurs, and may have been the source from which the Online Etymology Dictionary derives. The OED also gives the reference to the earliest known appearance in print in 1838.

Ambiguity of "OED" acknowledged. You should all know which one I mean.

[only_human]

Originally Posted by xilman

The OED concurs, and may have been the source from which the Online Etymology Dictionary derives. The OED also gives the reference to the earliest known appearance in print in 1838.

Ambiguity of "OED" acknowledged. You should all know which one I mean.

The Oxford English Dictionary is definitively awesome.

[Nick]

It came, it saw, and it concurred.

[Dubslow]

Originally Posted by henryzz

I would never have considered that lorry was a word only used in the UK not the USA. You need to stop losing words from our language.

Originally Posted by only_human

We did not lose this word. You coined the word all on your own:

In many ways, modern American English is much closer to the British English of the 1700s than modern British English. Among other things, our accent/pronunciation is much more similar to your 1700s pronunciation. You're the ones who've since evolved away from it

[only_human]

Originally Posted by Nick

It came, it saw, and it concurred.

Venimus, vidimus, vicimus GEGAN.