GOUT

[cmsummit]

I have it in my wrist and it sucks. It's really put a damper on the kayaking and my golf game lately.

I had my first flare up two summers ago and the doc diagnosed me with tendinitis. Only recently after the 2nd flare up, did I figure out (on my own with a little help from WebMD) that it was gout. I woke up one morning and my wrist was swollen, sore and I could barely move it. I hadn't suffered any trauma or injury so I couldn't figure out why it was so sore. With another misdiagnosis from the doc, I did a little research of my own and figured out is was gout.

Turns out that even though it occurs most commonly in the foot/big toe, it can happen in any joint. WebMD, listed it as "commonly misdiagnosed as tendinitis or a sprain". Purine rich foods like red meat, shellfish and beer are two of the worst foods you can consume if you have gout. Yep, it's barbecue season and I've been eating quite a bit of red meat off the grill and drinking lots of beer. It's also hereditary, and my dad gets it in his foot. Flares up can happen quickly as well, like overnight.

I'm really just glad I know what the hell is wrong with my wrist. I've been drinking black cherry concentrate as it helps break down the uric acid crystals that cause gout. I've also temporarily stopped eating red meat, curbed my drinking habits some and try to stay hydrated. It seems to be working, since my wrist feels about 90% now. Time for some chicken and wine!

[mock1]

ALLAPURINOL. You got to see a Doctor and get a prescription. but it works.
Good Luck.

[linds-o-rama]

Ugh. Wrists suck. I was recently diagnosed with arthritis in both knees (I'm 28), and when I was at my ortho discussing knee surgery (not arthritis-related), I pointed out a bump on the top of my hand that was MEGA PAINFUL. Like I couldn't really move my left hand, let alone type, carry anything etc. She laughed, said it was arthritis, and that it wasn't a big deal. Turns out she was right -- I was fine in about 10 days. Best of luck to you!

[Tippster]

Just got diagnosed with Gout in my big toe. Holy fucking shit does this stuff hurt.

[BobMc]

Just got diagnosed with Gout in my big toe. Holy fucking shit does this stuff hurt.

Bummer, sorry to hear that Tipp. I get that shit quite frequently. It started in my feet and the last couple of times have been my hands. Last ski season I actually skied a day while I had it in my toes. I made 8 runs before the pain brought me to the truck. Getting my boot off wasn't a whole lot of fun.

I had to completely quit drinking beer, I haven't had an attack in the last six months (knock on wood). Quitting drinking beer was the last try before going on medication. So far it's been working.

[doughboyshredder]

Just got diagnosed with Gout in my big toe. Holy fucking shit does this stuff hurt.

Isn't it the worst?

I take allopurinol daily. Without it I have a constant ache in my toes, which sometimes turns in to full blown pain. I gave up trying to treat it with diet and anti-inflammatory drugs. Been dealing with it for too many years. Allopurinol has been keeping it at bay for about 9 months now, I think. There are some foods I avoid, especially fish.

They will try to treat the pain with Diclofenac. Fuck that noise. It doesn't do shit. You need the real deal. Also, of course, drink a lot of water. Epsom salt soaks help as well.

[Tippster]

I had to completely quit drinking beer, I haven't had an attack in the last six months (knock on wood). Quitting drinking beer was the last try before going on medication. So far it's been working.

You? NOT DRINK BEER? Does not compute...

1st thing the doc asked me was "do you drink red wine?" I literally had to keep myself from laughing. He said I may need to stop "for a while." He also recommended cutting down my red meat and bacon intake. I serious'd and asked him if I should just kill myself right there in his office or wait until I get home.

Not even 24hrs after starting on some prescription anti-inflammatory (and not drinking any alcohol) I feel worlds better. Drinking all this water makes me piss every fucking 30 minutes tho - that's starting to get old already.

[BS720]

I had the typical swelling in great toes on either side. Crippling pain. Went to the foot doc, and he said its not gout, but arthritis. Bone on bone in the great toes. Nothing good to report, but maybe better to check in with a specialist before diagnosing yourself with webMD. It changes your management, and that's worthwhile in the grand scheme.

[skinnyskier]

Wine is fine. It's the beer and liquor which will get things riled up. Also, and many docs don't know this, high fructose corn syrup can also provoke a gout flair.

Regarding treatment of a gout attack, I favor low-dose colchicine if diclofenac didn't work. We used to use very high doses which caused a lot of diarrhea but that's now considered inhumane.

[DeutschBag]

I know a few things about gout. I suffered horrific attacks in most of my major joints, sometimes two or three joints at the same time, for over 15 years. Even my moderate gout attacks were more painful and harder to deal with than any other injury that I have ever had in my life (and the list is extensive).

I basically chronicled my struggles with gout here: http://goutactiveperson.blogspot.com/

I really, really need to update this site, though. Especially the diet portion.

The bitch about gout is that it is a bit different for everyone. However, there are a few things almost everyone can do to be proactive in controlling the disease.

1) Have your blood uric acid levels checked when NOT suffering from any gout symptoms. DO NOT have them tested during an attack. It will give useless and false results. You ideally want your blood uric acid levels to be below < 6 mg/dl. Above this level, crystals will deposit in the soft tissue of your joints.

2) Discuss this with your doc, and find a new doc if he won't do this. During your next flare-up (not after or when you aren't experiencing any gout symptoms) get fluid drawn from the infected joint and have this fluid tested for uric acid crystals. It is best to go somewhere that can test the fluid on-site, as any transport or jiggling of the sample can mess with the results (trust me). This is the only sure-fire way to know for sure that you have gout. Don't be a pussy - go do it. It's not that bad.

3) If gout is confirmed through fluid extraction and you have elevated UA levels, it's time to start formulating a plan. I would not wish what I went through on anybody. The sooner you understand what is happening to you, the sooner you can put yourself on a path to controlling your gout. I was misdiagnosed for 15 years. I was told I had everything from Lupus to Cancer. Most doctors knowledge regarding gout is extremely antiquated and they often times dispense horrible advice to gout sufferers.

Below depends on frequency of attacks, how bad the attacks are, how long you've had gout, etc... but it is my initial advice to anyone that has recurring attacks - usually happening more and more frequently as time passes:

Are you drinking alcohol? Any amount? Stop it - NOW. At least give your body the chance to see how it responds to eliminating alcohol from your diet.

If you are having attacks that are getting in the way of your lifestyle, talk to your doctor about getting on a UA lowering drug. This may be a lifetime commitment if your gout is bad enough. I say may be, because I'm working on getting my Allopurinol daily dose down slowly, but surely - and it's working. I'm down to 300mg/day now.

Eat Real Food!! No more junk food, cut out gluten and chemicals and diet sodas and all the other shit that makes up a modern diet. I have been strict paleo (Archevore, actually) for a year now, and the changes in my body have been amazing. I eat a shitload of red meat, bacon, etc, but GOOD quality meats (grass fed, no hormones, nitrate free, etc..). Eat your fruits and veggies. Avoid unnecessary sugars! This includes substances that your body will transform to sugars (namely bad carbs).

Drink plenty of water.

don't waste your time or money trying homeopathic cures (expensive dark red cherries, black bean broth, baking soda, etc... They don't work!). Your entire life will become devoted to seeking out cures that minimally help. I've watched people chase these 'natural remedies' for years and with little to no results (I used to be one of them).

And remember - THERE IS NO CURE FOR GOUT! You can only control gout, not cure it. Sorry guys, you're some of the unlucky ones. Either your body can't process UA normally or it can't excrete it normally. The drugs help it do this. My theory is that eventually won't need the drugs once my body is entirely free of built up UA deposits in my joints and I maintain a diet free from modern 'food'.

-----

I haven't had a gout attack in over a year now. It took about 18 months to cleanse my body, and it was horribly painful and quite the ordeal to live through. But, I did it. I highly doubt any of you have gout to the degree that I did, so your journey should be a lot easier and shouldn't take so long.

Hit me up with any questions you may have - I'd be happy to help. One of these days, I'll update my gout blog so it reflects what I'm doing these days to stay gout free. Now, to get my back taken care of tomorrow. Percutaneous Disc Nucleoplasty on my L4/L5 instead of surgery. I swear - it never fucking ends. You defeat one ailment, and......

[Hutch]

wow, timely bump. I'm up 2 hours earlier than usual because my ankle feels broken. Just got back from a week in Kauai, where I ate bacon every morning, drank beer all afternoon, then mai tais and raw tuna for dinner almost every night. In the back of my mind I knew I was asking for it.

[DeutschBag]

wow, timely bump. I'm up 2 hours earlier than usual because my ankle feels broken. Just got back from a week in Kauai, where I ate bacon every morning, drank beer all afternoon, then mai tais and raw tuna for dinner almost every night. In the back of my mind I knew I was asking for it.

Indomethacin worked very well for me - for my first 3 or 4 attacks. If you're further along than that, get some colchicine. Make sure you understand how to take this drug or you'll be pissing out of your ass for days. I once had an unfortunate incident while surfing in a wetsuit in Japan while on colchicine. Fed the fishes good, I did.

Speaking of colchicine - another reason to hate drug companies and their practices.
http://www.slate.com/articles/health...et.single.html

Don't drink alcohol for the pain. I spent a couple of years doing that (when I was unaware I had gout). Long story, and a really shitty time for me.

During a really bad acute attack, low-dose prednisone and percocet usually got me through the worst of it in 2 days. Docs will frown upon this and try to give you NSAIDS and (now expensive) colchicine. Yeah, like f'ing Aleve and drugs that induce pissing out my butt when I can't even walk to the bathroom is really going to help my ankle that is swollen up larger the Dirk Diggler's dong. Keeping some semblance of sanity during an attack is important. If you're in agonizing pain, can barely walk, can't sleep, can't get comfortable......you can lose your marbles quite quickly. Knocking the inflammation out fast should be your first priority - that's what the prednisone will do. The Percocet is just to help with the pain - and you're frame of mind. If the doc balks at this suggestion, ask him/her if he/she has ever had a gout attack. When they say no, then tell them they don't know what the hell they are talking about. I've seen women who suffer from gout describe the pain as being worse than childbirth. There you have it.

Hope that helps somewhat and you get to feeling better. Sounds like you had a nice trip! Next time, smoke the local and skip the booze

[Tye 1on]

Fkn hate gout. Been struggling with it for 8 years or so. Went six just gimping thru and nuking with ibuprofen. Not recommended. Two years ago went on Allapurinol. Kept having flairs, went on that plus one colchicine/day. Had a good year, ~ 1 flair. Two years ago started working out w/trainer, one year ago got more serious, and started hitting 2-3 yoga classes/week. Also got diet dialed in, no fast food, sodas, etc.

Six months ago dropped the Allopurinol. Have only had one flair since, nuked it in 24 hours. Unfortunately, alcohol does seem to be the key. I still have a few/day, but if i do a 3-day runner with microbrews, good red wine, and booze, i'm just asking for it. One big night, then back to cheap beer and 2 glasses wine/max, i'm fine. Gin and tonics somehow set me off too, had my first T&T in two years last week in Floride, sumbitch that tasted good. Good luck mags...and great info from DBag there...

[skinnyskier]

Mostly reasonable advice but I call bs on four things. If a physician had to have an illness in order to treat or prevent one, we would have to shut down the hospital. None of our orthopods have ever had a joint replaced, and I've never had a heart attack. Second, having an illness doesn't necessarily give any special insight in how to treat it. I guarantee you any rheumatologist knows more about gout than any lay patient, no matter how well informed. They probably treat five to ten cases a week. On the other hand, patients need to really get educated, since about half stop uric acid lowering therapy after its been started. gouteducation.org has some good materials. Third, an animal purine is an animal purine; it doesn't know if its cow was grass fed and hormone free. Finally, cherries actually can SLIGHTLY lower uric acid levels (like 1-2 mg/dl).

Sorry, but allopurinol is generally a life-long commitment. Its really rare to maintain the uric acid level below 6 with lifestyle modifications alone in someone who has had a bunch of gout attacks. If you can, that's awesome.

[Hutch]

Indomethacin worked very well for me - for my first 3 or 4 attacks. If you're further along than that, get some colchicine. Make sure you understand how to take this drug or you'll be pissing out of your ass for days. I once had an unfortunate incident while surfing in a wetsuit in Japan while on colchicine. Fed the fishes good, I did.

I have 2 Indomethacins left and was about to call for a refill until I read this post. I don't like taking it, it makes me kind of woozy and spacey. Thank you for your comments, I will try the colchicine.

Fkn hate gout. Been struggling with it for 8 years or so. Went six just gimping thru and nuking with ibuprofen. Not recommended. Two years ago went on Allapurinol. Kept having flairs, went on that plus one colchicine/day. Had a good year, ~ 1 flair. Two years ago started working out w/trainer, one year ago got more serious, and started hitting 2-3 yoga classes/week. Also got diet dialed in, no fast food, sodas, etc.

Six months ago dropped the Allopurinol. Have only had one flair since, nuked it in 24 hours. Unfortunately, alcohol does seem to be the key. I still have a few/day, but if i do a 3-day runner with microbrews, good red wine, and booze, i'm just asking for it. One big night, then back to cheap beer and 2 glasses wine/max, i'm fine. Gin and tonics somehow set me off too, had my first T&T in two years last week in Floride, sumbitch that tasted good. Good luck mags...and great info from DBag there...

Is it the alcohol or the sugars that trigger it? Other flareups I've had seem to come after vacations where I drink lots of beer in the afternoons and then wine or cocktails in the evening, so I don't have a controlled study.

Mostly reasonable advice but I call bs on two things. If a physician had to have an illness in order to treat or prevent one, we would have to shut down the hospital. None of our orthopods have ever had a joint replaced, and I've never had a heart attack. Second, having an illness doesn't necessarily give any special insight in how to treat it. I guarantee you any rheumatologist knows more about gout than any lay patient, no matter how well informed. They probably treat five to ten cases a week.

Should I just skip seeing my general practitioner and ask for a referral to a rheumatologist?

[jimmy]

Gout sucks.

Indocine works if you take it when you start to buzz, wait til you're ready to cut your foot off and the indocine is a waste.

Colcrys + MJ work much better if you are under attack.

Be careful if you are weaning yourself off of a daily use medication, lot's of people end up with kidney stones.

I seem to have fewer flare ups during ski season, maybe increased activity helps? I certainly don't drink less or eat better during ski season.

[Tye 1on]

.

Sorry, but allopurinol is generally a life-long commitment. Its really rare to maintain the uric acid level below 6 with lifestyle modifications alone in someone who has had a bunch of gout attacks. If you can, that's awesome.

I hear ya, and agree. Doc told me that's one thing he hates about allopurinol, that once you start, you're on it for life. I noticed no side-effects, so if i go back on it, no big deal on that end. If i'm not mistaked, UA levels over 6 don't automatically end up with flares, but having flares almost certainly means you have a high level. I.E. some people can naturally process higher than 6 w/o flares.

I have 2 Indomethacins left and was about to call for a refill until I read this post. I don't like taking it, it makes me kind of woozy and spacey. Thank you for your comments, I will try the colchicine.



Is it the alcohol or the sugars that trigger it? Other flareups I've had seem to come after vacations where I drink lots of beer in the afternoons and then wine or cocktails in the evening, so I don't have a controlled study.




Should I just skip seeing my general practitioner and ask for a referral to a rheumatologist?

Like somebody posted above, some asshole pharm company just bought the FDA approval on cholchocine, and jacked the price from $2/30 to over ten times that. If you find a pharmacy that has the cheap stuff left, hoard it.

Think it's the alcohol, for me anyway. Particularly booze for some reason. My sugar intake doesn't vary much at all outside of booze.

fwiw i'm with a great integrated internal medicine specialist. If not a rheumy, i'd at least be with an internist...

[DeutschBag]

Mostly reasonable advice but I call bs on four things. If a physician had to have an illness in order to treat or prevent one, we would have to shut down the hospital. None of our orthopods have ever had a joint replaced, and I've never had a heart attack. Second, having an illness doesn't necessarily give any special insight in how to treat it. I guarantee you any rheumatologist knows more about gout than any lay patient, no matter how well informed. They probably treat five to ten cases a week. On the other hand, patients need to really get educated, since about half stop uric acid lowering therapy after its been started. gouteducation.org has some good materials. Third, an animal purine is an animal purine; it doesn't know if its cow was grass fed and hormone free. Finally, cherries actually can SLIGHTLY lower uric acid levels (like 1-2 mg/dl).

Sorry, but allopurinol is generally a life-long commitment. Its really rare to maintain the uric acid level below 6 with lifestyle modifications alone in someone who has had a bunch of gout attacks. If you can, that's awesome.

1) Hyperbole on my part. Just trying to illustrate the amount of physical pain that can occur. Most doctors I saw (GP's, Orthos, Rheumas) needed to listen better. 95% of the ones I saw worked off of the standard prescriptive guideline of Indo + Colch + Allo and rarely took in to account history and never asked about diet. They just dispensed the general, "no red meat, no alcohol, no shellfish, take these pills that I've told you nothing about".

2) I beg to differ. Depends on the person and how motivated they are to get better. It depends on a lot of things. After getting no results or any help for over a decade, I changed my approach and began asking a lot of questions. When I had my monthly blood test done, I asked for the results and learned what those results meant. I knew how different results would generally affect me and how I felt. Would I beat a doc at a game of medical trivial pursuit? Hell no. It was a Rheumatologist, however, who had me giving myself shots of MTX. No Rheumatologist ever suspected I had gout - it was an orthopedist here in Germany who finally got me on the right track (and he couldn't believe how nobody else could have caught it).

3) Eating animal purines wasn't my point. You should know that purines aren't the main cause of gout. The point is, many doctors have been dispensing horrible dietary advice based on USDA recommendations for over 30 years. I think there is a strong correlation between systematic inflammation and gout (and numerous other autoimmune diseases) along with heredity and other factors. Grass-fed and healthy meats are going to help lower this inflammation in a lot of people, along with staying away from things like gluten and HFCS.

4) Yes, cherries, black bean broth, chugging baking soda-laden water, eating flax, and other things can help lower UA. I have no idea where you're getting your figure for cherries lowering UA levels that much, though. The general consensus that I've come across is that diet alone can probably only lower your UA levels by 1-1.5 mg/dl. To do that eating cherries? You'd have to eat a pound a day. From my experience of testing my blood monthly for over 2 years and following an AMA recommended diet at that time, my UA levels were only affected by two things - Allopurinol and drinking no alcohol.

By the way, here are the general AMA recommendations for gouties:

> high in complex carbohydrates (fiber-rich whole grains, fruits, and vegetables)
> low in protein (15% of calories and sources should be soy, lean meats, or poultry)
> no more than 30% of calories in fat (with only 10% animal fats)

That's really bad advice.

Look, obviously you've taken offense because I badmouthed doctors. I generally don't make blanket statements, but for the sake of brevity, I did take some liberties with my writing. I do apologize for that. However, I had some really, really bad experiences with doctors and my gout for a really long time. I also met some great doctors who were very nice, but who didn't have the experience or skills to help me. Most docs I saw had very little experience with treating gout. I actually had a doc open up a reference book to give me advice on treating gout (this was in Alaska). Here in Germany, I was the only gout patient at one Rheuma clinic. Weird, eh? One thing that docs could learn is to listen better. Not all patients are morons, and although in America the medical community is reactive, there are patients who do want to be proactive. I've talked to a lot of docs who hate the system but who are essentially forced to play by the rules. It sucks, but I know some are working on changing this. At least most doctors in the US don't see themselves as God-like like so many of the arschlochs here in Deutschland.

With all that said, it IS the patient who needs to take control of the situation. You have to take the UA lower/excreting meds. You can't go on a bender and then wish the pain in your toe or ankle or wrist away. If you suspect alcohol is causing your gout, quit f'ing drinking! (took me some time to learn this...). If you don't, you'll be just like all the sad sacks on the gout forums I used to read and participate on who keep doing the same thing over and over and expecting different results.

Sorry for the length. In this type of forum, there are always going to be holes left for people to pick at. I don't claim to have the definitive answer, but I know what has worked for me and it has worked for others that I've coached through the process. Eat REAL food (not USDA or AMA or AHA eating), take your drugs, no alcohol, enjoy life. Pretty easy

[DeutschBag]

One last thing I just remembered that might clarify things a bit - I was either misdiagnosed or gout was completely overlooked because none of the docs I went to had 1) ever seen it that bad 2) had never seen it occur in multiple joints at once. The textbooks and their knowledge told them that what they were seeing was very abnormal for gout so they pinned it on something else. If I was only experiencing attacks in one big toe at a time, it probably would have saved me a ton of misery and money. Unfortunately, cases like mine are becoming more and more common and I've noticed a lot more studies concerning gout recently. Hopefully this will help others get diagnosed and treated a lot earlier and quicker than I was.

[AlpiNord]

Bumping this old thread to ask if others have noticed 'triggers' other than diet and alcohol consumption causing flare ups?

After minor knee surgery a year ago, my left ankle became swollen, bright red and too painful to walk. It felt like some bone fragments were in the joints. Fast forward to this week, and a month or two prior, and my right toe flared up and felt like others indicated. The most recent seemed related to wearing old shoes that were to small, cramming the toes while walking the dog over a few days and a few missions each day. The other more recent one seemed to be about the time the same right toe was wedged against sheets that were too tight while sleeping.

[willywhit]

Bumping this old thread to ask if others have noticed 'triggers' other than diet and alcohol consumption causing flare ups?

After minor knee surgery a year ago, my left ankle became swollen, bright red and too painful to walk. It felt like some bone fragments were in the joints. Fast forward to this week, and a month or two prior, and my right toe flared up and felt like others indicated. The most recent seemed related to wearing old shoes that were to small, cramming the toes while walking the dog over a few days and a few missions each day. The other more recent one seemed to be about the time the same right toe was wedged against sheets that were too tight while sleeping.

been there, it went away. I used to get the crystalized protein in joints from eating fatty foods like bacon or greasy chicken. Kills for a few days and goes away. Feels like shards of glass in the elbow.
Last summer I got adema in my legs and feet. Got tested and they came up with nothing. Kidneys and liver were fine. Compression socks and elevating my feet when sleeping helped and it finally went away. I'm 53 and not skinny, never have been, plenty of beer and brisket, that'll do it.
never used to bother me until I hit 50 ish. Stay healthy, that's the ticket. Salt and sugar are not your friends

[billyk]

Bumping this old thread to ask if others have noticed 'triggers' other than diet and alcohol consumption causing flare ups?

After minor knee surgery a year ago, my left ankle became swollen, bright red and too painful to walk. It felt like some bone fragments were in the joints. Fast forward to this week, and a month or two prior, and my right toe flared up and felt like others indicated. The most recent seemed related to wearing old shoes that were to small, cramming the toes while walking the dog over a few days and a few missions each day. The other more recent one seemed to be about the time the same right toe was wedged against sheets that were too tight while sleeping.

The thing I’ve noticed is that inflammation feeds on itself, and snowballs into a full attack. I keep a supply of indocin on hand and take one whenever I feel an attack coming on. If I catch it early enough, that’s all it usually takes. I’m also on allupurinol daily, so the attacks are pretty scarce these days.

[Thaleia]

Checking in. Have had it for many years, mostly in my big toe. Was formally diagnosed a couple years ago and prescribed Colchisine which did very little. Over time i switched to Endomethicin and it works but takes several days to be comfortable again and it makes me feel woozy as hell.

This afternoon it just exploded in my knee. Can't sleep due to the pain. Sitting down in a cramped spot ei the toilet is almost overwhelmingly painful. Literally shivering from the pain at points. And that is with morphine. (yes, making an appointment with the Dr first thing AM).

I do find during periods of intense activity I seem somewhat gout-proof. In the summer when I'm mtbing tons I never get it, regardless of my diet / alcohol. In the winter when I'm alpine and nordic skiing lots, same thing, never get it.

Only when I'm sidelined with an injury or can't get out for weeks due to weather, work, commitments etc it returns.

[billyk]

Indomethacin (indocin) is an NSAID (non steroidal anti inflammatory drug). The key words are anti inflammatory. The inflammation comes from the uric acid crystals forming in your joints and tearing them up when you move. So you should try to keep the movement of the affected joint to a minimum until the attack passes. Rest, ice and elevate the joint are other things that help reduce inflammation.

Indocin is effective at treating gout, but it can have bad side effects, like liver damage over the long term. Definitely see a doctor and get a uric acid blood test. Ask him if he thinks you should be on a preventative medicine like alluprinol to help lower the uric acid level.

[Thaleia]

^^ Understood and agreed %100.

Last night was rough. Tried to lie down - the pain would get so intense I'd be essentially paralyzed at points. Not trying to be overly dramatic, those in this thread already know, but godamn this is worse than when my appendix ruptured.