“When they are hyperthyroid, they are the life of the party,” the chief said with a forlorn voice. “Euthyroid, they are fat and dull.”
The chief’s comments would be considered politically incorrect today but, as I have grown older, I realize the truth of the chief’s remarks. I always remember his words and still often cite them on rounds.
The Saddest Condition to Prevent?
Like my chief, I have been feeling reflective of late. After all, I recently became eligible for Medicare. (Incidentally I was shocked to learn that Durham County, N.C., offers a choice of 36 drug plans for Medicare, although thankfully that is down from 47. Yikes, how do I choose? But that is a discussion for another column.) In my current state of mind, I have recently asked myself another question: Which disease is the saddest to prevent?
My answer was simple: gout. Hands down. No contest. The answer is gout because, outside of hypouricemic agents, prevention involves telling the patient to turn his back (this is a man’s disease, after all) on some of the great joys of life. Even if they are bad for you, eating, drinking, and other indulgences that send uric acid levels skyward are a hell of a lot of fun. A life of the metabolic straight and narrow would no doubt be good for the kidneys and joints but would leave the soul diminished, if not weakened. No more rolling the good times if you want to keep crystals at bay.
I had clear evidence of this proposition recently when I spent a Halloween weekend in New Orleans to attend a wedding. As it turns out, that particular weekend is the second busiest of the year in the Crescent City because of the simultaneous occurrence of Halloween, a home game for the Saints (“Who dat?”), and a jazz festival. The city overflowed with tourists—pumped, wild, and shy on clothing but bedecked in beads—and, in my hotel, there were about 100 people from Pittsburgh who had made the pilgrimage to the home of the reigning Super Bowl champs for a four-day party of the best gut-busting, gout-inducing behavior you can possibly imagine. Shrimp, Andouille sausage, oyster gumbo, Abita beer, and a drink called a Hurricane (a sugar-bomb extravaganza of high-fructose corn syrup and rum) are the raw materials of a uric acid load that needs more than an infusion of uricase to handle. Although the alchemists of the past could never change lead into gold, the chefs of New Orleans can turn seafood and pigs into negatively birefrengent little gems.
