Gout

[Talbot]

Gout does sometimes hit elsewhere, but normally you also feel it in the normal spot as well. I have had it in both knees and that is a lot worse than my normal spot of left big toe. Best thing to do is to very quickly get a blood test done to find out what your uric acid level is.

It may be that you need to go on a pill to permanently reduce your acid level. I take Allopurinall (may be called something different in USA) and havent had an attack since taking it (thank goodness)


My ympathies

Seems to have been a short bout. I can almost walk today, but I have had this happen before. It hits hard, then subsides, only to come back in a few days for 2 or 3 weeks. I will ask about the Allopurinall. I am still determined not to have to take medications for the rest of my life, but I guess that is the price of getting older. Any idea what produces Uric acid?

[GordMay]

Gout is caused by the deposition of sodium urate (uric acid) crystals in the joints. Uric acid is a by-product of the body's metabolism. Saturation of uric acid in the human blood stream may result in one form of kidney stones, when the acid crystallizes into solid inside the kidney. A percentage of gout patients eventually get uric kidney stones. In human blood, uric acid concentrations between 3.6 and 8.3 mg/dL are considered normal by the American Medical Association, although significantly lower levels are common in vegetarians.

Avoid alcohol*, especially beer, and rich foods that are high in purine (purines are precursors of uric acid) or protein, such as:
- liver & kidneys (all organ meats)
- scallops, sardines, herring, mussels, and anchovies
- roasted nuts
- asparagus, peas, and beans
- gravy
- cream sauces
- mushrooms
- fried foods, and those made from or containing refined white flour.
- red meats (most experts advise eating no more than 6 ounces of lean meat, poultry or fish a day for nearly everyone)

*Excess alcohol generally means more than two drinks a day for men, and more than one for women, or those over age 65. Avoid ALL alcohol during a gout attack.

Other preventative measures include the following:
- Drink plenty of fluids (especially water)*
- Exercise regularly
- A balanced low-fat, high-fiber diet is recommended.
- Maintain a healthy diet and healthy body weight (gradual weight loss only, as rapid weight loss can actually increase uric acid)
- Black cherry juice neutralizes uric acid. Fresh cherries and fresh strawberries also help neutralize uric acid, as do nuts, seeds, and grains, although to a lesser extent.

* The uric acid crystals can be secreted in the urinary system as calculi (stones). Therefore you have to drink plenty of water, in order to wash out the urinary system and prevent any stones from developing.

Other risk factors include:
- Exposure to lead or beryllium in the environment
- Certain diseases and medications make it more likely that you'll develop gout. These include untreated high blood pressure (hypertension) and chronic conditions such as diabetes, high levels of fat and cholesterol in the blood (hyperlipidemia) and narrowing of the arteries (arteriosclerosis). Surgery, sudden or severe illness or injury, and immobility due to bed rest also can increase uric acid levels. So can the use of thiazide diuretics (used to treat hypertension) and low-dose aspirin as well as anti-rejection drugs prescribed for people who have undergone a transplant. In addition, chemotherapy treatments for cancer may increase the breakdown of abnormal cells, releasing large amounts of purines into the blood.

[Talbot]

Red wine and Port are particularly bad for gout sufferers.
Cheese can also cause an on-set

GORD, tanks for that detailed info. There is definately some new info in there for me. My diet is not perfect by any means, but it is relatively healthy. I do not drink much. Once every couple weeks I have a few drinks, but rarely beer. I do find it interesting that roasted nuts are bad, but nuts in general are good.
Talbot, I really like Port, but I realize it is one of the causes so I very rarely drink it. I have not had any outbreaks around the times I drink it, so I do not think it is a factor in my case. I have substantialy decreased my red meat intake over the past year. I have, however, recently had quite a bit of asparagas, and mushrooms. Something to consider.
It is worse today than yesterday. Not sure why, but that is the way it goes. If I can't walk by Monday, I will go to the local Doc in a box and get some meds.
I have a particuarly high tolerance for pain, but this is incapacitating even for me. Grumble grumble grumble. Oh well. I will get some cherry juice today, and take another look at my diet. I am not willing to give up meat, so I wil have to find a happy medium somewhere.

[CaptainK]

Hey Kai,

Could it be that the cold wet weather of Central Coastal California, might also have something to do with it?

Good thought Kevin, but it happens regardless of the temp and humidity. I have had flare ups in mid summer and mid winter. I am convinced that it is dietary, but just have not dialed in the main factors.
It is interesting how pain effects us. I have a very hard time analysing the cause of the pain wile I am experiencing it. And when it lasts for a couple of weeks, it is very hard to go back and pick apart exactly what I ate or did just prior to the flare up.
As I mentioned before, GORD pointed out a couple of factors I have not heard before. As I write this, I am thinking about the roasted nuts. I love peanut butter. I try not to go overboard with it, but over the past week I have had more than I usually do. Since it is made with roasted peanuts, it could be a factor. And, since it is one of my favorite foods, it would figure that it would be the cause of my problems. I hate getting older, but I guess it beats the alternative.

[CaptainK]

Luckily for me. Over half of what GORD posted I love.

Luckily for me, I do not have that problem. I also think it could be the person. DNA genetics? Call-it-what-you-will?

[Talbot]

CaptainK

You may have meant it in jest, but it is recognised that genetics play an important part in gout.

Both my father and grandfather suffered so I didnt stand a chance!

[CaptainK]

Well Talbot,

I basically just mentioned, "according" how alot of doctors now days say things like. "Genetics. If a family has a history of certain ailments." I think you get the point. I was just stating the obvious!!

And Kai. If your family history is plauged with "gout?" Then the answer might be gentically traited? Sorry to hear that you have that problem!!

Hopefully, Talbot. I hope that you do not have to go through, what your forefathers have? Good Luck!!

There is some history of gout in my family. As I mentioned a while back, I think my grand father may have had it, and a certain well known writer suffered greatly from the results. He happens to also be distant relative.
Talbot, How often did your gout act up before the medication?
I understand it is progressive, and am curious what stage I am at.
For the past few years, when it has flared up, the desire to remove the limb was very strong. This last couple of times, It included a fever, and flu like symptoms. I was too wiped out to think. Were there any steps possible to relieve the pain? I have tried over the counter pain relievers, ice packs, hot compresses, elevation of the joint, immobilization of the joint, and even a dieretic to try to cleanse my system. No effect whatsoever.

[CaptainK]

Hey Kai.

I sent you a email letter with some ideas. Hopefully, what they mentioned in them could help out?

Good luck!!

[Talbot]

The attacks started with a long period between events and started to increase in severity and reduce in periodicity. The last one took over 3 weeks to get me back on my feet and had been the second attack in 6 months. Hence the move to allopurinall.

You have to recognise that there are two elements in an attack of the gout. The first is the gout itself which primarily is merely the crystallisation of uric acid in a joint. It likes the damaged joint, and de-hydration raises the level of uric acid.

The second phase is the one which causes the damage. This is after the crystals have formed, and is caused by using that joint. This makes the crystals act as sandpaper inside the joint and inflames the bone and surrounding tissue. That causes more pressure on the joint and makes the crystals cause even more damage.

I have used Brufen (2x400mg & even 2x600mg 4x day) Diclofenac with sodium, and also indomethacin. All of these help to relieve the pressure, but they will only work if you eliminate all movement on that joint. They also provide a painkilling element which in some ways is a disadvantage cause it persuades you to start moving again too soon. It is only drugs such as allopurinall which reduce the uric acid level and allow the crystals to be re-absorbed, and it is only after they have been re-absorbed that it is safe to start movement again.

In early years, the bodies natural defences initiate the re-absorbtion process, but in my case, this proces was getting slower and slower - hence the one a day pill for the rest of my life.

[Alan Wheeler]

I was joking with a mate the other day, about us getting to a stage in life, where we measure our age by the number of pills we have to take. I am still young at only two/day.

Talbot, thanks for that. I think I am at that point where long term meds are a possibility, as I am also in the less frequent, more severe stage.
Wheels, I guess if I start on some long term meds, that means I am officially old