From: ((Steven B. Harris))
Subject: Re: Ecstasy.  Anyone hear of this?
Date: 23 Jun 1995

In <3scpck$gpq@newsbf02.news.aol.com> athame1@aol.com (Athame1) writes:

>>It has been called a euphoric amphetamine
>
>undoubtably to distinguish it from the more familiar non-euphoric
>amphetamines, such as meth, benzedrine.......
> <smirk>


These last aren't euphoric for a lot of people.  They don't call it
"crank" for nothing.  For example, the effect of amphetamines on me
personally (besides the usual fatique dissipation) is that I get
impossibly angry with the establishment.  Enough of this stuff and you'd
probably find me buying ammonium nitrate at the local fertilizer store.
It's an effect that is very unpleasant for me, and definately not worth
it.  The effect of ecstasy, however was very different and much sweeter.
 Naturally, shortly thereafter, they outlawed it.

                                           Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: pheochromocytoma help.....
Date: 21 Feb 1999 15:35:43 GMT

In <7akcej$lf0$1@cletus.bright.net> "Sherry" <rn2b@bright.net> writes:

>Hi all,
>I have been lurking for months on this ng.  Occasionally I respond, but this
>time I need a little help.
>BTW, I am a first year RN student.  My boyfriend went to the Dr. the other
>day and got some disturbing news.  He was sent to see a cardiologist. The
>cardiologist wants to do a bunch of tests on him to test for
>pheochromocytoma.
>A little background first:
>--48 year old male
>--diagnosed with hypertension when he was 16. currently takes Enduron(sp).
>diagnosed with narcolepsy when he was 24.  He has been taking 60 mg. of
>Dexedrine daily for 24 years now.  There are days when he only takes 10 or
>15 mgs. though.  He doesn't abuse them.
>--a few months ago he bagan taking Viagra.  He occasionally had difficulty
>maintaing an erection.  This has cured that problem.
>--He now takes tagament for heartburn.
>    The problem is; when he went to his family doc, his pulse was 117.
>This naturally concerned his doc.  This is why he was sent to see a
>cardiologist.  My boyfriend has never had any sort of chest pain and his
>heartbeat is regular.
>The doc is wanting to do an echocardiogram, a 24 hour urine collection and
>numerous other tests on his urine.  When I looked all of these tests up in
>my textbook, they all point to pheochromocytoma.
>The doc said, "having high blood pressure since you were 16 is not normal."
>My question is; Can one of you explain a little about this disease to me?
>What else do you think it could be?
>I know medical treatment is important and I am not posting this to keep him
>from seeking medical treatment.  It is purely for my own peace of mind...
>
>Thanks so much,
>Sherry
>rn2b@bright.net
>icq 23088412



    Does this cardiologist know the man takes 15-60 mg of Dexedrine a
day?  I can't wait to see what the urine catecholamine value is.

    Hay, Ammoncircuits--- do you suppose he could have secondary
hyperthyroidism?

     Seriously, Sherry-- in medicine, common things are common.  People
with pheochromocytoma are uncommon.  People who have it for 28 years
(which is the theory, here, right?) are uncommon squared.  People who
have it for decades while they medicate it with speed are uncommon
cubed.  It some point, disbelief begins to set in.

    People on uppers who say they don't abuse them, but do, by
contrast, are very common.  And so are people on uppers with
tachycardia and hypertension.  And people who have hypertension for no
reason that anybody understands.  It's not common to have hypertension
at 16, but not uncommon, either.  Or to have found a source of illegal
uppers which would do that to you, in 1970.

    Anyway, have fun with that urine test.  When it gets to the point
that they want to do selective renal vein sampling, looking for the
source of the bad chemicals, let us know.


                                  Steve Harris, M.D.

From: David Rind <rind@enterprise.bidmc.harvard.edu>
Newsgroups: sci.med
Subject: Re: pheochromocytoma help.....
Date: Sun, 21 Feb 1999 16:24:35 -0500

Steven B. Harris wrote:
>     Does this cardiologist know the man takes 15-60 mg of Dexedrine a
> day?  I can't wait to see what the urine catecholamine value is.

[stuff inbetween deleted]

>     Anyway, have fun with that urine test.  When it gets to the point
> that they want to do selective renal vein sampling, looking for the
> source of the bad chemicals, let us know.

I just wanted to reiterate Dr. Harris' point, since I'm not
sure it will come through clearly to the original poster: dexedrine
will create a clinical (and urine testing picture) that will look
just like pheochromocytoma, and it's important that whoever is
looking for pheo be made very aware of the Dexedrine.

--
David Rind
rind@enterprise.bidmc.harvard.edu

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: pheochromocytoma help.....
Date: 22 Feb 1999 09:41:34 GMT

In <7aqf7j$vqj$1@nnrp1.dejanews.com> ammoncircuits@my-dejanews.com
writes:

>In article <7ap94f$62b@dfw-ixnews8.ix.netcom.com>,
>  sbharris@ix.netcom.com(Steven B. Harris) wrote:
>
>>     Does this cardiologist know the man takes 15-60 mg of Dexedrine a
>> day?  I can't wait to see what the urine catecholamine value is.
>
>I would suspect so.  You probably have noticed that he has been taking this
>medication for quite a long time and it was started AFTER the HTN appeared.


    Uh, huh, sure it was.  They said to him-- "Hmmm young man, we see
that you have hypertension.  However, we're going to start you on this
here Dexedrine anyway, with no other medications.  Best of luck and do
call if you see black spots in your eyes."

   Think that's the way it went, Ammoncirc?



>THAT is what is driving this workup - not necessarily his present
>symptoms, although those do help I imagine.

    Yes, that is what is driving this workup.  Right.  A guy whose been
on Dexdrine for 24 years, and is now gettting checked out for
hyertension, with the full pheo workup 28 years late, because he says
he had hypertension since 16.  Not that anybody did anything about it
duing all that time, of course.  Though somebody has obviously been
prescribing Dexedrine for 24 years.  A likely story.  If true, somebody
ought to literally be prosecuted.  But I prefer to think we're just not
getting the truth.  Not that your truth detector is worth a damn.



>>     Hay, Ammoncircuits--- do you suppose he could have secondary
>> hyperthyroidism?
>
>Hay?  You are the one pushing pituitary TFTs for Nancy, Harris.


    Not unless her standard TFTs of drugs are abnormal, Ammonia.



>>      Seriously, Sherry-- in medicine, common things are common.
>This is his "horses not zebras" line in different form.

    Damn, I may actually be teaching you something.


>> People
>> with pheochromocytoma are uncommon.
>
>So are people who have had hypertension since the age of 16.


    For more uncommon than that.  But whether this guy actually had
hypertension from age 16, we cannot tell.  The internal facts of the
story argue strongly against it, as noted above.  But I know you're all
waiting to explain it to me.


>Well, Sherry did not say what the workup was at age 16, but if there were a
>pheo work-up done, I don't think the physician in charge of the case would be
>repeating it, do you?


    Nope.  And after 28 years it's hardly necessary to do it the first
time, either.  But I suppose there's always the chance of writing up
the case for the New England Journal of medicine: 28 years of
pheochromocytoma successfully treated with dexedrine.  The doctor would
be famous.  It could happen.


>There are probably other tests that should be done to
>work this up as well.  It may even be a good idea to put the patient
>on another treatment for narcolepsy - if that's still a problem.

    Gosh, yes.  Did my sarcasm actually lead you to this, or did you
think of it all by yourself?  Good luck in getting him to stop.


> That may even  cure his impotence problem and he won't have to buy
>all that costly and dangerous Viagra.


    Cure of impotence by withholding of sympathomimetics.  Now, that's
likely.  What would be the mechanism?  Perhaps you can get into the New
England Journal, too.  "The patient was in the midst of amphetamine
withdrawal and fast asleep, and yet a strange tumescense was noted.
Nitric oxide release by unknown mechanisms, as a result of blood
pressure lowering, was postulated."  Hey, it could happen.

                                     Steve Harris, M.D.

From: David Rind <rind@enterprise.bidmc.harvard.edu>
Newsgroups: sci.med
Subject: Re: pheochromocytoma help.....
Date: Mon, 22 Feb 1999 08:47:29 -0500

Shapere wrote:

> My understanding of pheochromocytoma is that it doesn't generally
> cause sustained hypertension so much as periodic paroxysmal
> hypertension. Or is it both?

Pheo can cause sustained or episodic hypertension, or both, or
neither.  It depends on whether there is basal or pulse secretion
of hormones, and which hormones are secreted.  Of those patients
with pheo who have hypertension, about half have sustained
hypertension that looks like essential hypertension, and about half
have paroxysmal hypertension.

--
David Rind
rind@enterprise.bidmc.harvard.edu

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: pheochromocytoma help.....
Date: 23 Feb 1999 00:34:27 GMT

In <19990222114647.06128.00000665@ngol05.aol.com>
shapere@aol.comicrelief (Shapere) writes:

>In article <36D15FF1.6956@enterprise.bidmc.harvard.edu>, David Rind
><rind@enterprise.bidmc.harvard.edu> writes:
>
>>Pheo can cause sustained or episodic hypertension, or both, or
>>neither.  It depends on whether there is basal or pulse secretion
>>of hormones, and which hormones are secreted.  Of those patients
>>with pheo who have hypertension, about half have sustained
>>hypertension that looks like essential hypertension, and about half
>>have paroxysmal hypertension.
>
>Well that's confusing. How do you know when to screen for pheo in those who
>have only sustained hypertension, then?
>
>-elizabeth


   Big debate on that.   Mostly it's done in people too skinny or young
or without enough family history to suggest it's the garden variety
"essential" type.  Or people who are tachycardic or unusually
refractory to therapy.  Doing it 28 years after onset of signs, in
somebody middled aged who is chronically on amphetamines, however, is
pushing the odds unmercifally.  Either the story we've been told is
wrong, or somebody's clinical judgement in deciding to do this workup
sucks the big one.

                                      Diplomatically,

                                      Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: alt.health,sci.med,alt.parenting.solutions,sci.psychology.misc,
	alt.psychology.help,alt.health,alt.suburbs
Subject: Re: Ritalin Side-Effects Explained//Parents "Caught in the Middle"
Date: 28 May 1999 10:09:16 GMT

In <7ilep1$jbo$1@news.cyberhighway.net> "Derek A. Wholeflaffer A.S.A."
<smcqueen@cyberhighway.netXYZ> writes:

>To my mind, the primary question isn't whether Ritalin is effective (the
>evidence seems to be that it is, not only for ADD but also as an
>alternative therapy for depression- especially post-CVA) but whether ADD
>is being over-diagnosed. In other words, are kids being tagged as ADD
>when in fact the real problem is the home environment, social
>environment, school environment, nutritional, relationships, needing
>glasses, other problems such as a central auditory processing disorder,
>etc.?
>
>This is the part of the debate that is currently raging, I think, not the
>medical efficacy of Ritalin. (At least, that's the focus of the Ritalin
>controversy in my neck of the woods).


Comment:

   The real focus of the controversy should be the unfortunate fact
that ADD (at any age) is only a "disease" in the way that hypertension
and hypercholesterolemia are diseases.  It's just one end of a spectrum
of degree of difficulty in focusing attention on one task for effective
periods, and the amount of it which one needs, in order to be labeled
as having a "disease" is largely arbitrary and socially constructed.
It's not as though there is a gene or any kind of marker for physical
damage which can be assessed, here.  There are tests with scores, but
they only confer the illusion of objectivity, for the cutoff for the
score which makes the diagnosis is itself subjective.

   Alas, a dose of methylphenidate, exactly like a dose of amphetamine,
aids allertness and performance in nearly all tired people-- something
long established in studies, and long used by the military (the Germans
at the Battle of the Bulge in late 1944 probably being first to exploit
our modern versions of these chemicals).  And nearly all people working
at a difficult schedule or heavy school study load are tired.  Thus,
these drugs are quite effective learning and attention focusing aids
for most people, which is the reason for their widespread use among
college students.  You may call this "abuse" or "self-medication"
according to your philosophy.  But your philosophy is the only thing
which differentiates the two, and this is a heavily judgemental issue
(something like the question of who is and isn't "sexually
promiscuous"-- answer: the person who has sex with significantly more
people than YOU do, is).  Too often, "abuse" merely means "use the
doctor didn't sanction" but otherwise the same, and for the same
purposes.  There's a heavy dose of hypocrisy, there.

   The Apollo 13 astronauts-- frightened, isolated, cold, exhausted,
thirsty, and in one case infected, took amphetamines on doctor's orders
on their last leg of the journey before re-entry, a period in which
many complex and unrehearsed tasks had to be done, and during which
certain simple mistakes meant death.  Instead of collapse into the arms
of the doctors after being plucked from the sea in their capsule and
put on deck, these half frozen and tortured men emerged from their ship
smiling and waving and standing on their own feet.  Perhaps looking
around for a floor to vacuum, or some income taxes to catch up on.
That's amphetamines.  In my mind's eye I have a picture of these
sterling heros promptly being denouced by Nixon as a bad example to the
nation's youth, who are expected to get high on life, and not rely on
an artifical chemical to help them achieve.  Unless someone tells them
they can.  That is, if given permission by *authority*, why then it's
all right.  It's not alright if they decide for themselves.  How dare
you decide for yourself about something like that for your own body,
and your life?  Why, the very idea.

   THAT is the real message we're sending with trimethylphenidate, aka
speed.  And the disease we're looking at is a lot worse than ADD.  It's
a worship of authority, and the idea that you'll be told what to do by
the proper authorities, and you'll be evil if you decide for yourself
what to do, instead.  The Germans had this diease bad in 1944.  So did
the Japanese.  Let's hope that in this era of big government, it's not
too catching in America.  From all the signs, though, I'm not too
hopeful.
                                       Steven B. Harris, M.D.