Gout

[Skinypupy]

Been having massive pain in my right big toe over the last few months. Thought it was a re-aggravation of an old turf toe injury, but it turns out that I have gout. As my doctor put it, gout is basically very similar to kidney stones, except the uric acid crystals form in the joint of the big toe. No one is quite sure why it forms in the toe...seems kinda random. Causes major swelling (to the point where I can barely get my shoe on) and a lot of pain. Seems to be triggered quite a bit by diet, mainly red meat, beer, and anything with lots of sugar.

Other than a complete diet overhaul (which is in progress, and something I need to do anyways), there are a couple treatment options: steroids being one, and another medication (the name escapes me ATM) being the second. Tried the steroid thing a couple weeks ago. Made things better for a few days, but now it's back to being massively painful again. The other medication is a "last resort" option, since once I start it, I will have to be on it for the rest of my life. Not exactly something I want to start unless I absolutely have to.

Just curious if anyone around here has run into gout and if you had any recommendations, medications or otherwise. It doesn't help that whenever I tell anyone why I'm limping around, they response is always "Oh, my grandpa had that". Or, as my boss put it, "I thought gout was something that only old-timey prospectors and pirates got!" I told him I'll be calling in sick next week with scurvy.

[dbt1949]

Oh, my youngest stepson had that. He was only in his mid 30s. Went to the doctor pretty regularly but still seemed to take months to heal.

[LawBeefaroni]

Or, as my boss put it, "I thought gout was something that only old-timey prospectors and pirates got!" I told him I'll be calling in sick next week with scurvy.

No way, he needs some gout-u-cation. It's the disease of kings and rich merchants! Congrats!



I was denied the status of this most auspicious of afflictions recently when my painful big toe was ruled out as gout and instead is most likely related to a fracture when I was a kid (PTO driveshaft fell on it and I dropped a rock on it later the same year).

[LawBeefaroni]

Ah-ha, see:

The painful illness is known as the disease of kings as it afflicted a number of monarchs including Henry VIII.

Hospital admissions have almost doubled in a decade to more than 4,400 a year.

(PUBLISHED: 08:17 EST, 30 September 2012)

I remember it being tied to a lot of heavy drinking and eating a lot of meat/rich foods. Still not sure how I've managed to avoid it.

[Skinypupy]

Wikipedia has a very apt illustration of gout from the early 1800's



Yep, that's pretty much what it feels like.

[malchior]

I have gout - actually just got through a flare up early this week. It will likely not confine itself just to the big toe. That just happens most often. The last one affected my entire left foot but I've had it affect my shoulder before once and a few other random joints. The foot is the worst because generally it is very debilitating -- walking can become practically impossible even with crutches.

The most important thing to consider is that the diet modifications they talk about are basically impossible. The list of foods that you should avoid are basically every form of meat, fish, all beans, several vegetables and probably water. It won't happen. I've never found eliminating any food to help. You will get random acute attacks until you manage the uric acid levels in the body and that will just make them far more infrequent but will likely still occur on occassion. Control comes from several possible medications - the most popular generally being allopurinol. It will help keep uric acid levels below the level that crystals will form in the bloodstream.

For flare ups - the key is to attack fast. Cholchicine/Naproxen are the 1-2 punch. Cholchicine is an ancient gout medicine that is very effective on its own and sometimes used to be used as a prophylactic (every day use) but that has fallen out of favor. The Naproxen (Aleve is Naproxen) will act as an anti-inflamatory to reduce swelling. This is important because an acute attack is really a cycle that spirals out of control. Crystals get lodged in a joint -> The body sends white blood cells to attack the foreign body -> the white blood cells crash against the crystals and attack causing swelling -> The white blood cells die and release a protein that lowers blood pH -> More crystals to form -> Inflamed joint catches more crystals. The key is breaking the cycle, stopping it early and resolving it. I don't know the complete mechanism of Cholchicine but I believe it interrupts the metabolic pathway that allows uric acid crystals to form.

[Teggy]

First of all it's THE gout.

My dad has it, although I haven't heard him complain about it in many years. I'm guessing this is due to him eating better. He used to take medication for it. Sorry that's not very helpful, but at least you get a video.

[malchior]

Oh one more thing - this is a little P&R but most people don't know about this but will be important to a gout sufferer - Colchicine is marketed now as Colcrys by the way. It is a medicine that has been used for hundreds of years for gout and a few other diseases. It was dirt cheap - as in pennies a pill. Then the FDA said - this drug is *untested* it may be *unsafe*. They created a program to test old untested drugs and one company took them up on it - proved it was safe and now has an exclusive monopoly to sell colchicine. It now costs approximately $5 a pill. But now we know the ancient medicine is safe. Thank god.

[Skinypupy]

First of all it's THE gout.

Awesome.

Thanks for the info malchior, that's really helpful. I'm going back to see the doctor this afternoon and will run an couple of these medications by him. I took some ibuprofen this morning that has helped a little bit, but will switch to Alleve next time.

[Scuzz]

I have two friends that suffer from gout. I remember when the first guy told me he had that problem I thought he was crazy but no, I was just ignorant.

[ericb]

I have it (and I also had my first flare up in my early 30s) and it's hell. My first time was in my ankle and it basically feels like a bad sprain except no matter how you wrap it, soak it or elevate it the pain stays the same. I've since had it move to my other foot and my toe in flare ups since then. I also don't buy the food not causing it because I have trigger foods that guarantee a flare up by the next morning. My main triggers are asparagus and the nitrate or preservative they use in Gwaltney meat products. Switching brands, avoiding heavy nitrate foods and avoiding asparagus has kept me free of a major flare up for close to a year now.

I will mention that the last flare up was causing by asparagus...and I had a total of 2 half stalks. That's basically one piece. I think once you get it you ride the edge of a flare up and even a slight indulgence is enough.

BTW it never goes away. And the medicine has enough side effects you're better off living with the pain and changing your diet.

[Skinypupy]

I have it (and I also had my first flare up in my early 30s) and it's hell. My first time was in my ankle and it basically feels like a bad sprain except no matter how you wrap it, soak it or elevate it the pain stays the same. I've since had it move to my other foot and my toe in flare ups since then. I also don't buy the food not causing it because I have trigger foods that guarantee a flare up by the next morning. My main triggers are asparagus and the nitrate or preservative they use in Gwaltney meat products. Switching brands, avoiding heavy nitrate foods and avoiding asparagus has kept me free of a major flare up for close to a year now.

I will mention that the last flare up was causing by asparagus...and I had a total of 2 half stalks. That's basically one piece. I think once you get it you ride the edge of a flare up and even a slight indulgence is enough.

BTW it never goes away. And the medicine has enough side effects you're better off living with the pain and changing your diet.

May I ask which medications you take for it? Trying to weigh medication options here and be better informed for this afternoon's appointment.

Also, do you guys use painkillers stronger than ibuprofen/Alleve for flare-ups? I get nervous going down that road (not even sure if the doctor will do it), but I would have killed for something stronger last night when it felt like my toe was being stabbed with hot needles at 3am.

[malchior]

I also don't buy the food not causing it because I have trigger foods that guarantee a flare up by the next morning. My main triggers are asparagus and the nitrate or preservative they use in Gwaltney meat products. Switching brands, avoiding heavy nitrate foods and avoiding asparagus has kept me free of a major flare up for close to a year now.

I more meant it is impossible to avoid all the foods they say do not eat. If I drink a lot of beer - especially with a steak - it will occasionally just hit.

BTW it never goes away. And the medicine has enough side effects you're better off living with the pain and changing your diet.

It is unfortunately genetic - so absent some future gene therapy we are stuck. My experience with the medicine is no (noticeable) side effects but *far* fewer acute attacks. The trade off despite cost is a no-brainer for me. The most common side effect is skin rash and if you have that then they switch you to an alternative.

[Toe]

Also, do you guys use painkillers stronger than ibuprofen/Alleve for flare-ups? I get nervous going down that road (not even sure if the doctor will do it), but I would have killed for something stronger last night when it felt like my toe was being stabbed with hot needles at 3am.

Most doctors, especially ones that are familiar with you, should not have any problem issuing a prescription pain killer to you. A simple "I took some alleve and ibuprofen to alleviate the pain but it did not help." Or you could go with something like "I would say my pain level was a 9 (out of 10). When I took some alleve it went down to maybe a 7 for an hour or two.". Unless the doctor has self-imposed policy of not prescribing pain medication (some do, btw, to avoid having to deal with the recreational users/addicts that come in trying to get some prescribed) you should okay.

[malchior]

Also, do you guys use painkillers stronger than ibuprofen/Alleve for flare-ups? I get nervous going down that road (not even sure if the doctor will do it), but I would have killed for something stronger last night when it felt like my toe was being stabbed with hot needles at 3am.

My first attack I was prescribed hydrocodone. I did not take it. I don't like painkillers and I don't think it'd help. The dosage that the doctor would likely write is 500 mg Naproxen which is effectively 2.5 aleve pills OTC and it can be hard on the stomach.

Colchicine's side effects are occasional -- mostly gastrointestinal - probably 1 out of 10 flare ups. I have no problem trading that for not walking.

[Kasey Chang]

I've been advised by my brother, who is a physician, that the strongest OTC painkiller that won't kill you if you overdose a little is Naproxen Sodium.

Aceotomenophen *can* cause liver damage if you overdose by 50% in some people.

When I have an attack I just take 3 pills instead of the normal 2. And drink LOTS AND LOTS of water to "flush out" the uric acid, and try to eat less red meat and other uric acid sources.

[Trent Steel]

Seems to be triggered quite a bit by diet, mainly red meat, beer, and anything with lots of sugar.

Based on this, I should be riddled with the gout.

[Smoove_B]

If it makes you feel any better, my roommate in college came down with the gout during summer break. He went home and worked as a landscaper, drinking tons of coffee and eating pork roll every day for breakfast. I think his family doctor re-ran the tests a bunch of times because he didn't believe a 19 year old could get the gout.

You could also comfort yourself in knowing it was once called "the disease of kings".

Sorry, I've got nothing.

[Jeff V]

Didn't Bobby Hill get it after becoming addicted to fried liver at the local diner?

A friend of mine had a whole summer ruined when he developed it. I used to have dinner with his family a lot and was known as "the freak who kept bringing salad." Hell, if I didn't, there would have just been meat.

[Biyobi]

I had my first gout attack about three years ago at 40. It's alternated between left and right big toes but seems to favor the left. The first few attacks were screamers and matched that Wiki picture. After doing a lot of reading I've cut my alcohol consumption to nearly zero, cut back pretty far on my red meat consumption, dropped some weight and cut sodium down to lower my blood pressure, and make every effort to remain properly hydrated.

For me, I've noticed that the hydration part is incredibly important and I haven't had a real attack since early summer (knock on simulated wood grain). It took a while to figure out how much more I needed to be drinking once the real "sweat season" started. I can have an evening of drinking or a steak dinner now and then if I'm also putting enough water away.

When I have an attack I just take 3 pills instead of the normal 2. And drink LOTS AND LOTS of water to "flush out" the uric acid, and try to eat less red meat and other uric acid sources.

Same for me, though I stick with the normal two pills (and weed, it's medical!)

[dfs]

What Malchior said. Both about the disease and treatments and about the FDA being from the guv'ment to help us.

I've used both Colchicine and Allopurinol. I took myself off the Allopurinol because I hated being on maintenance scripts. Before I was on that, I had a couple of attacks a year and as long as I treated recognized what they were quickly enough I was able to treat them with Colchicine. I've been gout-drug free now for 3 months.

Just for what it's worth, I've never managed to nail down a food that acts as a trigger, but I have noted that stress tends to make the condition flair up in me. My doc laughs at the notion, but since I started paying attention I've noticed every attack has come during a stressful social situation.

[Isgrimnur]

now has an exclusive monopoly to sell colchicine

Used to have an exclusive monopoly.

Appl No	Prod No	Exclusivity Code	Exclusivity Expiration
N022352	001	I - 603	Jul 30, 2012

They got a patent for almost 30 years, but they have no more exclusivity. Not that it will do much for pricing.

[Skinypupy]

Thanks everyone for the input, it's been incredibly helpful. Met with the doc this afternoon, with a couple outcomes:

- I'm doing another round of Prednazone to try and get the existing attack under control.
- After this attack is done, he wants me to start Allopurinol to see if that helps regulate the uric acid levels.
- He thinks a better diet (i.e. no alcohol, less red meat, etc.) will be helpful, but cautioned that it won't prevent attacks entirely. Said that I should pay close attention when an attack does occur and see if there is any consistency on what I ate prior to it.
- Ibuprofen/Alleve as soon as I start feeling pain is a must. Ice baths to counteract the swelling also "couldn't hurt".
- Gave me some Lortab to manage the pain from this attack.

You never realize how much of a problem a toe issue can be until you have one. Got to the point this afternoon where I could barely walk. Really hoping this attack gets over before I have to get on the plane Monday. Walking around DC for two days on a bum foot doesn't sound like much fun.

[ericb]

Yeah, medicine wise I'm only using pain killers...even my doctor said it wasn't worth starting the medicine unless it was long term and incapacitating. I'm not sure I buy the red meat/shellfish cause though since I didn't have a single flare up when I was low carb (queue the genetic / everyone is different causes ). It sucks but on the scale of things that really suck long term it's only about a 2. Just remember it will feel better a week or two later and a month later you won't even remember having it. Until the next flare up

[Odin]

Add me to the list of people who thought gout died out around the time of the Industrial Revolution.

[Isgrimnur]

You haven't seen the ads?

[Kasey Chang]

- I'm doing another round of Prednazone to try and get the existing attack under control.

Prednisone. That's an immune suppressor. It doesn't handle your existing inflammation, it just tells your body to stop attacking the joint.

I remember that I used to get indomethecin (aka Indocin), which is a prescription strength NSAID much stronger than even ibuprofen / Naproxen. But it can make your stomach feel really bad (not to me though).

Colchisin is for people who can't do NSAIDs, but it has more side effects.

Allopurinol suppresses your body's production of uric acid. It's not always needed. There's another drug called probenecid that will make your kidney work harder and dump more uric acid via urine. But diet improvement is probably easier.

[Skinypupy]

You haven't seen the ads?

Those were actually the very first thing that came to mind when I realized that it was gout.

[Odin]

You haven't seen the ads?

I guess I just don't watch the same old man TV shows you do.

[KKBlue]

I'm self diagnosing but I'm pretty sure I gotta The Gout. Holy shit it it painful and I've puked from kidney stone pain. I would put The Gout pain at an 8 where the stones made it to 11.

Blood work done yesterday. X-Ray later today.

I don't eat a lot of sugar (something white sugar about every two days or more) and don't drink as much as I would like (one beer every other night, few more on the weekends). Either way, guess I'll have to be controlling the intake to a greater degree. On the bright side, it will be one way to lose more weight without exercising, ha! Honestly, if I was to choose, it would be my water intake needs to increase.

Actually bought some cherry juice before The Gout and have some frozen cherries in the freezer I'll pull out. Someone, somewhere on OO mentioned the fruit to be helpful when I was doing a search on The Gout.

Anyways, never a dull moment for sure!

[Skinypupy]

Sorry KK, I feel your pain (literally). Hopefully your flare-ups will be like mine...they hurt like hell for a few days, then subside completely.

I only had two flareups all of 2014, one around June and one right before Christmas. Have yet to get one this year...knock on wood. I haven't really made any dietary changes, but have made an effort to stay more hydrated, drinking at least 2 liters of water a day. I can only assume that's made the difference this year.

[Toe]

I have not had a flareup since my initial bout of gout, I guess a year ago? It hit me after a full day of drinking a lot of beer (for me) and eating a lot of barbecue (red meat) at a friends party (maybe a 12 pack and a lunch and dinner of mainly red meat). It was in the summer, so probably was not very hydrated either, I think we played disc golf earlier that same day. So anyway, I immediately stopped drinking beer, although I have had 3-4 beers a handful of times since then. I drank cherry juice for several months, but eventually stopped. I also now avoid red meat as much as possible. If there is a choice, I always go with non-red meat now. Every once in a while I will get some heat/burning sensation in my toe. When that happens I don't drink beer or eat red meat until it subsides.

[Paingod]

The guy I share an office with has gout and isn't happy about it. He loves barbecue and red meats in general. He's not a heavy drinker, but likes to socially drink. He has to temper both or his body reminds him that he's not an invincible 20 anymore, but rather an aging 40. He says asparagus, even a single serving, can cause a flare up... so he avoids it entirely now; he used to love it.

You have my sympathies. It sounds really painful.

[Kasey Chang]

I had a flare up about 3 weeks ago, but heavy bout of naproxym (triple the recommended dose) and a ton of liquids took it back down.

I'm surprised upon reading the naproxym bottle that recommended dose was 3 caplets a day. I took 3 that morning, then 2 at 8 hour intervals. The flare up lasted about two days. I was quaffing about 4-5 20 oz bottles of dietcoke a day though, plus other liquids.

[KKBlue]

Thanks for the posts.
I will always find it amazing how much something from the inside of the body can cause severe pain. Such a fascinating machine the body is!

The X-Ray technician chose to move my foot by placing her hand right on the joint where most people would grab a foot. I slammed my hands down on the table making quite a sound. She looked at me with her hands up to her chest from recoil and said, "I guess the area is tender hun?" My face replied without words. Needless to say she did not attempt to maneuver my foot after that.

[Kasey Chang]

Set a reminder to drink water hourly. Don't need to be a full cup, preferably regular water, at least least diet soda and non-sugar stuff.

I include a caplet of naproxym as a part of my daily routine (along with blood pressure and blood sugar meds), double if I feel a twinge of pain at the big toe joint. Regular walking and lots of water (and going to restrooms) should keep the gout away. Meds are helpful for the short term, but for long term you have to change eating habits. Pretty sure my flareup was from a lot of beef that week (every meal, practically).

[hitbyambulance]

my dad came down with this last year. he drinks beer like it's water, tho.

[Kraken]

Beer is improved water.

[dfs]

What Malchior said. Both about the disease and treatments and about the FDA being from the guv'ment to help us.

I've used both Cochineal and Allopurinol. I took myself off the Allopurinol because I hated being on maintenance scripts. Before I was on that, I had a couple of attacks a year and as long as I treated recognized what they were quickly enough I was able to treat them with Colchicine. I've been gout-drug free now for 3 months.

Just for what it's worth, I've never managed to nail down a food that acts as a trigger, but I have noted that stress tends to make the condition flair up in me. My doc laughs at the notion, but since I started paying attention I've noticed every attack has come during a stressful social situation.

well, Hi there earlier me.

It's now been 2 years since I took myself off Allopurinol and I have not had a serious gout attack in that time. I think the big change has been self awareness. Where before I would not notice an attack until I was wondering...Did I hit my toe on something and break it or is this a gout attack? Now, at the slightest twinge in my toe I'm shoveling naproxin and Cochineal down my throat.

Early treatment has kept the painful symptoms at bay.
Or I just haven't had an attack in two years.
one or the other.

[malchior]

Heh. I'll update as well. I went low carb about a year ago and haven't had a major flare up since. I record my gout pain daily aND it has been much lower since. However I am on vacation and generous beer is flowing which is odd for me. I had mild pain on the first day and bought naproxen but ended up not taking it. My guess is major weight loss plus low carb in general has helped fend it off at present.