False gout creates true pain

DEAR DR. DONOHUE: Will you please give some information on pseudogout? My husband has it, and not much has been written about it. He has suffered from it in his wrist, knee and ankle. Most people don’t realize there is a difference between gout and pseudogout. — A.S.

ANSWER: Pseudogout (false gout) got its name because it resembles gout in many respects. With gout, uric acid crystals infiltrate joints. With pseudogout, calcium pyrophosphate dihydrate crystals penetrate joints and the tissues around joints. Like gout, pseudogout comes on at older ages. Also like gout, the presence of crystals in the joint can produce attacks of intense pain.

Surprisingly, some people with CPPD crystals in their joints don’t suffer pain. Most do. And the crystals damage the joint cartilage. The affected joint swells and turns red. In gout, the joint at the base of the big toe is the one most often targeted for a first attack. In pseudogout, the knee often is the first target. However, the wrist, ankle, shoulder, elbow and hands are other joints where pseudogout strikes.

X-rays of an involved joint help make the diagnosis. Recovering joint fluid containing calcium crystals is the most convincing evidence.

The pain of an acute pseudogout attack increases in severity over 12 to 36 hours, and lasts from a few days to a few weeks. Between attacks, the joints are pain-free, unless they also have osteoarthritis, and often they do.

The nonsteroidal anti-inflammatory drugs — like Motrin, Aleve or Advil — often can end an attack. Colchicine, a gout medicine, also can control an acute attack. Cortisone injections into the joint bring rapid relief. If a person suffers frequent attacks, the daily use of colchicine can prevent them.

DEAR DR. DONOHUE: Two months ago, I found out that I have Meniere’s disease. My symptoms are ringing in my left ear and a decreased hearing in that ear. A long time ago, I had dizziness, but I don’t now. My doctor has me on a low-salt diet and told me to avoid caffeine, alcohol, tobacco and stress. He didn’t prescribe medicine. Is there a medicine that gets rid of the ringing? — A.A.

ANSWER: Meniere’s (main-YARES) disease is attacks of tinnitus (ear ringing), hearing loss and dizziness. Many also complain of a feeling of fullness in the affected ear. The attacks last from two to 24 hours. The time between attacks shortens so that, at some point, the symptoms become permanent. The cause is a fluid buildup in the inner ear.

A very-low-salt diet improves symptoms for many patients. Diuretics — water pills — also help. Surgery that shunts fluid from the inner ear is another possibility. The Meniett device creates pulses of pressure waves to the inner ear to displace fluid, and has been successful for some. For hearing loss, a hearing aid comes to the rescue. With improved hearing, tinnitus often decreases. No medicine gets rid of it. You should see an ear, nose and throat doctor who can review all the possible treatments and tell you which are best suited for you.

DEAR DR. DONOHUE: My grandson has epididymitis. Where does it come from? Is it curable? — Anon.

ANSWER: The epididymis is a comma-shaped structure on the back of the testis. It is a long — 15 feet to 20 feet — very slender, twisted tube, coiled so tightly that it fits in a small space. It provides nutritious fluid for sperm and is a temporary lodging place for them. Epididymitis (EP-uh-DID-uh-MITE-iss) is a painful inflammation of that structure, usually due to a bacterial infection. The bacteria come from other sites in the urinary tract or by way of sexual transmission.

This is a common condition. It’s responsible for 600,000 doctor visits a year in the United States. Antibiotic treatment almost always results in quick relief from symptoms and a complete cure, in most cases.

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. Readers may also order health newsletters from www.rbmamall.com.

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