DEAR DR. DONOHUE: Will you please explain myasthenia gravis? Has modern medical care improved the quality of life of a person diagnosed with this disease? What exactly is it? How is the thymus involved? Muscles and nerves are involved too, aren’t they? — C.K.

ANSWER: A little background information is needed. Nerves prod muscles into action by releasing a chemical messenger called acetylcholine. It swims across the gap between muscle and nerve, and attaches to muscles like a ship docks at a pier. The pier is actually called a receptor on the muscle. Upon reaching the receptor, the muscle contracts. In myasthenia gravis, receptors are clogged with antibodies. The connection between muscle and nerve cannot take place. The muscle makes only a weak response. Antibodies are products of the immune system. Myasthenia, therefore, is another autoimmune disease, an illness where the immune system attacks its own body — here, the nerve-muscle connection.

The signs of myasthenia are muscle weakness on repeated use of the muscle and early muscle fatigue. The eyelids droop. Chewing, speaking and swallowing are accomplished only with great difficulty. Double vision is common, because the eye muscles of the two eyes no longer work together. Arms and legs become weak. Early on, myasthenia comes in periods of worsening and periods with less obvious involvement.

The thymus gland in the upper chest functions abnormally in 75 percent of myasthenia patients. It is believed to be one big source of the antibodies that block acetylcholine from reaching muscles.

Today’s medicines allow an upbeat approach to treatment for most patients. In some, however, it remains a disabling illness. The medicine most often used in treatment is Mestinon (pyridostigmine). It increases the amount of acetylcholine reaching muscles. It’s not the only medicine available for treatment.

In many instances, removal of the thymus gland produces a marked improvement in the illness. When to perform a thymectomy is a call made by the doctor taking care of a myasthenia patient.

DEAR DR. DONOHUE: I read your item on colchicine, the gout medicine. I took it for years, never paying more than $34 for a three-month supply — $10 with insurance. Now it costs $284-$611 with insurance. No doubt pharmaceutical companies have found a way to make even more money. Even if I could afford this drug, I wouldn’t purchase it now. I will become accustomed to pain. — M.N.

ANSWER: Let me mention two other drugs useful in preventing gout attacks — probenecid and allopurinol (Zyloprim). Neither is terribly costly. And for an attack of gout, indomethacin (Indocin) is a good choice.

The story on the gout medicine colchicine is one that begins with the Food and Drug Administration. It forced the many manufacturers of colchicine to stop its production because they hadn’t submitted studies showing their version of the drug was safe and effective. This is the role of the FDA. Its action left one company as the sole manufacturer. It does seem that the escalation of cost for colchicine is a tactic that takes advantage of this unique situation that has been brought about by the FDA ruling.

For people who cannot afford the one colchicine drug left on the market, they can get a helping hand by contacting NeedyMeds at www.needymeds.org. For patients having to make a copay for their medicines, they can contact www.colcrys.com for help in deferring their copay cost.

DEAR DR. DONOHUE: My son tells me that he has a goiter on his gland. Is an endocrinologist the correct doctor to see? — R.O.

ANSWER: A goiter is an enlarged thyroid gland.

Your son can start out with a doctor who is a family-medicine doctor or a general internist. If the doctor finds his case too unique, he or she will refer him to an endocrinologist, a doctor who specializes in endocrine gland problems. The thyroid gland is an endocrine gland.

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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