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SOLVING THE MYSTERY OF CHRONIC PAIN AND FATIGUE

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- CASE STUDY SHOWS IMPORTANCE OF URINARY METABOLIC ANALYSIS

It was a mystery. For half a year, the two young brothers (aged 7 and

9), previously healthy and energetic, had suffered chronic headaches,

stomach and leg pains, fatigue, and weight loss. Their clinical

histories included nothing that could explain the onset of these

puzzling symptoms.

Routine laboratory testing, as well, revealed no abnormalities -

except for one thing. Analysis of urine samples showed that the boys

had abnormally high levels of vanilmandelic acid (VMA).

Vanilmandelic acid (also spelled as " vanillylmandelic " ) is a

metabolite of catecholamines - powerful chemicals, like adrenaline

and norepinephrine, released in response to stress. The body is known

to unleash a flood of these substances in response to mercury

toxicity. Thus, high levels of VMA alerted the clinicians to the

possibility that the boys may have been exposed to this highly

noxious toxin.

In fact, toxic element analysis in serum and urine confirmed that

mercury levels in both boys were extremely elevated. Faced with this

clinical evidence, the two brothers then confessed to having been in

contact with mercury (which they had previously denied): they had

stolen some mercury from a science laboratory and played with it

regularly in their rooms, hiding the fact to avoid punishment.

After chelation therapy was completed (monitoring with urinary

assessment showed a 10-fold rise in mercury excretion during

treatment), both boys recovered completely, with urinary mercury and

VMA levels returning to normal.

While not as common as it was before mercury was removed from many

objects used in daily life, acute mercury poisoning still occurs.

Nowadays, it happens most often when people are exposed to the

contents of broken thermometers, the case report authors observed.

NOTE: This case study, though uncommon, points to the importance of

thorough laboratory investigation of chronic " unexplained " symptoms

in patients. The Metabolic Analysis Profile can reveal

" below-the-surface " abnormalities often missed by routine laboratory

tests. In particularly, it can reveal hidden triggers of chronic pain

and fatigue in patients who are not responding to conventional modes

of diagnosis and treatment.

Find out more about the diverse clinical applications of this

versatile metabolic evaluation for gut health, neurological function,

nutritional balance, and energy production at:

http://www.gsdl.com/assessments/metabolic_analysis/

Great Smokies offers several Elemental Analysis panels for

identifying exposure to and clearance of a wide range of toxic

elements in samples of hair, blood, and urine. Find out more about

these profiles at http://www.gsdl.com/assessments/elemental

RELATED ARTICLES AND RESOURCES:

New Cases Of Childhood Mercury Poisoning Raise Concern

http://www.gsdl.com/news/connections/vol8/conn20000412.html#story2

Selenium May Reduce Mercury Toxicity

http://www.gsdl.com/news/connections/vol11/conn20010131-p.html

Source: Kosan C, Topalaglu AK, Ozkan B. Chronic mercury intoxication

simulating pheocromocytoma: effect of captopril on urinary mercury

excretion. Pediatr Int 2001;43:429-430.

© 2002 Great Smokies Diagnostic Laboratory

Call 800-522-4762 for more information or send your request for test

kits and educational materials to cs@...

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- NEUROTRANSMITTER METABOLITE REVEALS SOURCE OF GUT MALADY

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- ELEVATED 5-HIAA CALLED SENSITIVE PREDICTOR OF ACUTE APPENDICITIS

Ouch! It might be a wrenching pain in your colon. Or the feeling of

vise-grips being tightened slowly around your forehead. Or the

prolonged, nagging ache that lingers deep inside muscles and joints.

Pain is an important signal the body sends out to notify us that

something is amiss. Problem is, it doesn't always tell us precisely

what needs to be fixed. For that, a clinician may need to look more

closely at certain chemical metabolites that can better pinpoint the

problem.

Measuring levels of an organic acid produced from serotonin, for

example, could help clinicians more accurately diagnose and treat

various gut maladies - including acute appendicitis.

According to a recent study that evaluated 166 patients and 40

healthy controls, urinary assessment of the organic acid 5-hydroxy

indole acetic acid (5-HIAA) is " highly sensitive for acute

appendicitis " and " may be helpful in [making] exact diagnosis. "

In patients seeking urgent care for appendicitis, levels of 5-HIAA

(measured in spot urine samples upon hospital admittance) were about

ten times higher than in healthy controls.

" In clinically suspected cases this test confirms appendicitis with

98% sensitivity, 100% specificity, and 100% PPV [positive-predictive

value] and 93% NPV [negative predictive value], " the researchers

reported.

Improving diagnostic accuracy for acute appendicitis is important,

especially in elderly patients or in those who incur health risks

from anesthesia. Clinical symptoms alone, such as acute abdominal

pain, are sometimes not specific enough to determine with certainty

whether surgically removing the appendix is necessary.

The study found that measuring 5-HIAA in urine provides the

additional clinical insight needed. Normal levels of 5-HIAA were

reported in all of the patients admitted to the hospital with

apparent symptoms of acute appendicitis who were later found not to

be suffering from the condition - or who did not require surgery. All

the patients with increased 5-HIAA levels, on the other hand, turned

out to have appendicitis or some other type of gut disorder, such as

gastroenteritis.

What does 5-HIAA, a metabolite of the mood-altering neurotransmitter

serotonin, have to do with gut function?

Besides altering mood and behavior via the brain, serotonin also

functions as a key regulator of inflammation and pain in the body.

When faced with injury, specialized cells in the gut lining release

serotonin. Cell depletion of this substance may trigger abdominal

pain; over time, it could even progress to conditions such as

appendicitis, experts have conjectured.

Higher levels of serotonin released by traumatized gut cells are

broken down into the metabolite 5-HIAA and then eliminated in urine.

That makes urinary assessment of 5-HIAA a good indicator of this type

of gut dysfunction.

NOTE: 5-HIAA is an organic acid marker that provides important

insight into neurological and gut function on the Metabolic Analysis

Profile. This assessment also measures metabolites of other key

neurotransmitters, such as dopamine and norepinephrine, displaying

these markers within a visual diagram of neurotransmitter pathways

for clearer interpretation. View a sample report at

http://www.gsdl.com/assessments/metabolic_analysis/reports/index2.html

RELATED ARTICLES AND RESOURCES:

5-HIAA Monitors Experimental CFS Treatment (1998 Conference Abstract)

http://www.cfids-me.org/aacfs/session2.html#forsyth

Hypothesis: Neurotransmitter Analytes As Markers In ADHD Children

(2000 Symposium Presentation)

http://www.uclm.es/inabis2000/symposia/files/116/

Source: Ilkhanizadeh B, Owji AA, Tavangar SM, Vasei M, Tabei SMB.

Spot urine 5-hydroxy indole acetic acid and acute appendicitis.

Hepatogastroenterology 2001;48(39):609-613.