Anyone here have gout?

[azasadny]

I believe the intense pain in my large toe on each foot is gout. My brother had it a few years ago and now I believe I have it. I'll need to contact my Dr and get the lab tests done to make a definitive diagnosis. Funny thing is, I'm a 80% vegetarian (only fish or chicken once or twice a week), no alcohol of any kind whatsoever, no animal fats or cholesterol, etc... due to my liver condition (NASH with elevated AMA and ANA). Seems strange that I have this. All I know is that it feels like a piano was dropped on my toe!! Anyone here have experience with the gout?

[slodave]

Talk to Noah930. It seems to be a monthly occurrence with him....

[Cornpanzer]

I started getting it last winter. Had a crippling case of it this spring where I couldnt even set my foot on the floor. In my case, I think I have narrowed it down to shellfish. I have cut out the shrimp and mussles and havent had a flare-up in about four months.

I was afraid it was red wine, but have been drinking plenty of that w' no problem.

My Doc prescribed an anti-inflammatory (Indocin I think??) and when I do feel it beginning to come on, I take some of this and it seems to head it off at the pass. He wanted to put me on a drug to lower the uric acid levels which are the root of the problem, but you are locked into taking that for life and I wanted to try and find a trigger food before medicating.

Good luck - it sucks! Interestingly, now that I have had it, I have spoken to far more people than I would have ever imagined that deal with it.

[URY914]

I have it between all my tile. Kitchen and bathroom.


Oh wait, you said GROUT with an "R".....................OK, sorry, my bad.

[NICKG]

i have it....it is immensly painful. Are you haveing a period of alot of stress? that is my trigger on my gout. I am having it now actually.....

[Mo_Gearhead]

My friend has it.

He swears that concentrated cherry juice helps?

[on2wheels52]

One of the cardplayers that used to hang around at the shop had it, he said it helped to drink lots of water.
Jim

[TimT]

He swears that concentrated cherry juice helps?

Yes. very helpful..

I get a epsisode of gout at least once a year, and eat cherries our drink cherry juice and it helps shorten length of the episode..

The pain from gout is unbearable

[jyl]

I had an extended period of severe pain in one ankle last winter, have had other episodes in past.

Docs said didn't seem like classic gout but they couldn't find any other cause and was eventually disagnosed as probable gout, although not for 4 months by which time it had mostly resolved. Treated with anti-inflammatories (which didn't do much), drawing joint fluid (helped a little), much time (spent limping around with a cane/crutches, in pretty severe pain at times), and finally with colchicine (a gout medication, which seemed to complete the recovery). 6+ visits to orthopedic and rheumatologist, x-rays, MRI, lots of blood testing, etc. Think total bill was appx $4K?

My friend the GP laughed at me when he heard this story - he said you should have just gone on gout medication immediately, inexpensive with few side effects, if was gout you'd have known and gotten relief quickly, why did you waste all those months and dollars in pain, ha ha pass the wine. I said thanks, doc.

[Tobra]

Originally Posted by Mo_Gearhead

My friend has it.

He swears that concentrated cherry juice helps?

Yes, it does

Key is diet and hydration. Caused by byproduct of protein metabolism, uric acid, forms sodium urate crystals, negatively birefringent, look like ground glass. Careful with the Indocin/Indomethacin, I don't prescribe that long term. Colchicine will give you pretty bad GI distress if you take too much.

Steroid injection will make you want to kiss the one who gave you the shot a kiss on the mouth. I give the victim a shot if it is bad.

[jyl]

I've heard people swear by glucosamine, in pill form or in drinks like cherry juice, cranberry juice, or "Joint Juice". I drank it when I was having my ankle problem, can't really say if it helped a lot but I thought it helped a little anyway.

When I was given the colchicine, I was also prescribed another drug to counteract the GI effects. I think it was omeprazole.

[masraum]

Originally Posted by Mo_Gearhead

My friend has it.

He swears that concentrated cherry juice helps?

I had a buddy that had it. He did the same. There's a health-food type series of juices called "Just ". There's a "Just Black Cherry". I told him about that and he said it worked wonders. He drank the whole quart in one morning. I didn't realize he was going to do that. One of the other side effects of those juices is that they'll clean you out. He spent about 20 minutes on the head.

[schamp]

Have a real close friend who used to get it all the time. He also took handfuls of vitamins everyday. Left his bag of pills in the car before a cruise and gout when away. Quit taking all of the pills and hasn't had a gout attack since. If you load up on vitamins everyday you might want to quit for a week or so and see what happens. Can't hurt.

[spyderman]

Both my father and I have Gout. We both just started getting it in the last couple of years. We are both on Allopurinol 300 MG and I haven't had an attack since I started useing it. For me it is red meat and beer. If I have either of those the next morning my toe starts to feel puffy. If un-checked it will be so painful I can't walk.

[azasadny]

Thanks guys! I went to the DR today and got blood drawn for lab work, a steroid injection, steroid tablets for a week. Nothing for pain or Colchicin because of my liver disease. I can't take any meds that could cause my liver enzymes to rise, so I'm "SOL" for pain. The Dr will call me when the lab results come in to discuss. Two "trigger foods" are asparagus and lentils and I ate a lot of those this week. I drink concentrated cherry juice mixed with water regularly, so I'll continue to do that. Thanks again!

[dedbird]

I too have a very similar diet and had terrible gout for a couple of years. Used the indomethicin to treat flare ups with good results (hit it early and at recommended times at the first signs) and eventually went on the allopurinol daily, which did not help much. I eventually identified that reducing salt intake and and better hydration were the solutions to my problem. By making those modifications I was able to eliminate all insistences of gout. No problems for two plus years. The underlying cause seems to be different for everyone.

[VaSteve]

Originally Posted by TimT

The pain from gout is unbearable

X1000

My dad had it a lot and I had no idea WTF it was. He'd have his foot up and said it was painful. First time I got it (after a rough weekend of some weird eating and diherrea, IIRC) I couldn't walk. It came on slowly and then it was excruciating. I was at work and had a long walk to my car. Every step was painful. It was my right foot and I was driving an automatic Jeep. I could barely work the pedals. We went to the hospital since I didn't know what it was.

[elwood-914]

I have had it, I suspected due to diet. I went on vacation and just didn't eat, so fasting can also bring it on.
My doctor gave colchisin. (sp?) I keep it on hand and one to two pills get rid of it.
I know when I am about to get an attack, while I am walking the affected joint starts to snap.

[Noah930]

Gout is pretty much an inborn error in metabolism. You've likely inherited the problem from your parents. Your body doesn't break down certain proteins as well as it should. So uric acid accumulates in your blood. Sometimes the acid crystals will precipitate out of your bloodstream, and they accumulate in joints. Particularly the metatarsophalangeal joint at the base of the big toe. That's called podagra. The joint becomes painful and swollen. Typically you can't even stand the pressure of bedsheets covering that toe, at night. However, gout can develop in any joint.

In my experience, both personal (moderately extensive) and professional (scant, as I don't see much gout as a hand surgeon), blood tests aren't necessarily that useful. Well, they seem to be more useful in textbooks than they do in real practice. I've found very few internists and rheumatologists to be interested in a patient's uric acid level. They only seem to order uric acid levels as an afterthought. A part of the textbook workup is to order a 24-hour urine collection (to help discriminate between over-producers and under-excreters, IIRC). I've never seen anyone do that. Finally, the definitive test for an acute attack is to aspirate (suck out) some fluid from the offending joint (though good luck approaching anyone with a needle when they've got gout), and looking at the aspirate under polarized light. There are characteristic negatively birefringent crystals to be seen. Only medical students do that.

People seem to make a big deal about diet. Personally, my gouty attacks don't seem to have much relationship with what I eat or drink. But typically it's alcohol and red meat that are villified. Asparagus seems to be related, too. Staying hydrated seems to be key. I've blunted many attacks of gout by just drinking and drinking water. My wife notices that I seem to have more attacks when I'm stressed. There's probably some cortisol/hormonal relationship.

Oral anti-inflammatories are usually prescribed for an acute (active) attack of gout. Things like Motrin/ibuprofen and Indocin/indomethacin. On paper, they're interchangable. Indocin usually is considered stronger. Personally, ibuprofen works, but indocin doesn't. Go figure. Not recommended due to liver and GI side effects, but I lived on 800 mg of motrin three times per day for 7 straight weeks, once.

Colchicine is also used. You're supposed to take a tablet every two hours until the pain goes away. Or until you can't tolerate the side effects. It's main side effect is diarrhea. Not a good side effect for a surgeon, plus it doesn't seem to do much for me, personally.

Tobra recommended to me cherry juice. I've tried that, and it's seemed to help me a little bit. $4 a bottle at Trader Joe's.

And the best treatment I've found has been an intra-articular steroid injection. Essentially a cortisone injection. It works as a concentrated dose of anti-inflammatory medication delivered to exactly where it's needed (as opposed to oral pills that go throughout your bloodstream). The standard party line is that it takes 3 or 4 days before the steroid starts to do its thing. However, my wife (a nurse) gave me the injection once, and I have to confess that the stuff worked virtually immediately. INCREDIBLE. Again, you'll be petrified at someone approaching your throbbing big toe with a needle. But the payoff is ridiculously worth it. The next time I had gout (this time in my ankle), the wife was out of town and wouldn't be back for several days. I couldn't bear any weight on my foot, the ankle throbbed so much. So, on a Sunday afternoon I gave myself the injection. This time it took 2 days to take full effect, but at least I didn't miss any work.

Once you've settled an acute attack, you can ask your physician if you should be on a regular medication (Allopurinol) to control your uric acid levels to avoid future attacks. Allopurinol is not to be used for an acute attack, as there is evidence that it may actually prolong an acute attack. I'm not on it (maybe I should be?), but several family members who are swear by it. Far fewer attacks, and when they present, they're much less severe.

[jyl]

Very informative, Noah, thanks.