Gout and the Effects of Time

In late 2010, I published an article called “Living with Gout: A Lesson in Self Discipline.” Since then, six years later, a lot of changes have taken place in my body, and not all of them were for the good.

Alcohol consumption back then was one of the major contributors to my gout problem. I really do love the taste of beer, and a good cabernet will always be welcomed at my house. But as I stated in the previous article, alcohol was a no-no. One glass of beer was equal to 2 or 3 days of pain. So I quit it all together.

But food was another issue. I stopped eating pork and cut down on red meat, but after dealing with gout for more than half of my life, 34 years, it seemed that my body became predisposed to have gout always lying in wait. I quit eating bread and meat altogether and lost nearly 100 pounds in a few short months. I was careful of what veggies I chose to eat, those that were low in purines, but still, the gout kept hanging around.

But through the years, gout had stepped aside and lent a hand in the onset of osteo-arthritis. The attacks were sometimes as severe as gout, but without the fluid buildup around the joint. Over time, the arthritis had worn away the synovium in my load bearing joints and the result was bone on bone friction, causing swelling of its own. In the swollen area around these joints, once aspirated, the doctor would also find uric acid crystals floating around. The attending ER doctors would call it a gout attack, but after 34 years of this stuff, you can tell the difference between the two.

A New Player in the Game

In late 2012, my whole left leg swelled up from the mid-thigh to my ankle. I was in excruciating pain. I went to the ER and the doctor decided that I had an infection in my leg. I was admitted and spent 7 days in the hospital receiving high doses of IV antibiotics. I was also treated with anti-inflammatory meds such as Toradol. I was also given colchicine and Dilaudid and morphine for the pain. As it turned out, I never had an infection, but I did have elevated uric acid levels (which seems the norm for me). There was a team of doctors trying to figure it all out, and a rheumatologist jumped in as a new player. He diagnosed me with Rheumatoid Arthritis. The swelling went down, but not because of the antibiotics.

Along with the pain, swelling and high uric acid, I also had nodules popping up everywhere, a classic sign of RA. Other symptoms included malaise and chills with a low grade fever.

Great! I have RA!

Is Diet the Key?

My wife began researching the foods I eat much more thoroughly than she had before. We began eating organic vegetables only, gluten free breads, organic chicken and grass fed beef. Sugar was limited (not fun!). My gout attacks became fewer and with less intensity when I did have one, but the osteo-arthritis had already done its damage and as long as I had to keep working, it was unstoppable. Bones were grinding against bones, causing more and more wear and tear. But the dietary changes that we had made had at least slowed down the gout.

Had I known this fact years before, it may be saving me a lot of pain now. Yes, diet is the key!

Pain and its Management

But the pain was and is still there. It is still at times excruciating. While the gout is easily controlled now, like I said before, it is lying in wait for that opportunity to attack a weakened joint. Most of the time if it attacks, it will be in my knees or ankles.

I have no more space left for synovium between the bones in my ankles and knees. It is bone on bone. I work in retail management now and spend nearly all day on my feet on hard concrete floors. Some days, by the end of my shift, I am near tears in pain. The doctor has given me Percocet and Vicodin for the pain, but I can’t do my job effectively if I take it while working. I have tried taking ½ a pill to take the edge off, which worked for a while, but then even that quit being as effective as it was.

So the doctor began regular steroid injections in my knees and ankles. With each shot a measure of lidocaine is added. It is not as painful as it sounds, and in the beginning it was quite effective. After about two years of these shots, I am needing them more frequently as they do not last as long as they should. I get them every three months. Any more frequent than that is harmful to my body.

I feel immediate relief (probably from the lidocaine) and can actually walk like a normal person for a few days, pain free. Then they begin wearing off, and I have to wait until it’s time for the next round. More pain.

Remedies?

My doctor says that I am a perfect candidate for knee replacements. He is trying to get me more time with my natural knees before he replaces them. The replacements have about a twenty-year lifespan, so the longer he can put it off, he says the better off I will be twenty years from now. He was trying to avoid the possibility of an 80-year-old undergoing another knee replacement.

Beginning next week, I am starting a series of “Rooster Comb” injections, or “Visco” shots. It is a sticky, thick fluid that oozes into your joints and sticks to the bones and acts as a type of synovium to make life a little easier. I’ll post the results here as they happen.

But the ankles are a different story. The replacement technology is out there, but it is not perfected. The current ankle replacement lasts about 2 years. Not worth it. My ankles are in such terrible shape that it couldn’t support it anyway. The bones are crushed in appearance via x-ray, and are already damaged because of the arthritis. At my present rate, they will be fused naturally in about 5 years, and there is a good chance that I will be confined to a wheel chair.

On the other hand, the doctor has recommended that I have them surgically fused and have orthopedic shoes made to accommodate the situation. I am already wearing orthopedic shoes just to make my walking more comfortable. They stabilize my ankles and cushion the bony protrusions on the bottoms of my feet (I can’t walk barefooted; it feels like I am walking on marbles).

Enter my wife. She is confident that she can cure my ailments with a super strict diet. I believe her. In a couple of years, you can read about it here.

Side Effects

I went to my family doctor, whose husband is my rheumatologist, and she decided to run some tests on me because I was always fatigued. Here we go again.

What she found was not good. Because of the years of gout, and because of the years of medications and steroidal shots (some given by her husband), I have developed Polycystic Kidney Disease. My kidneys are full of cysts, some of them as large as ¾ of an inch in diameter. While that sounds bad, it isn’t. It is common in men my age, but actually parallels gout treatments. But the not so good thing is that the steroids have negated the effectiveness of my adrenal glands by causing the glands to cut off my natural levels of cortisol.

The long term use of pain meds has affected my liver function. While it still functions within the normal limits of its purpose, I have extremely high levels of ammonia in my blood. (That explains why my wife says I smell funny, and why my socks smell like ammonia when I take them off at night).

But my wife says that she can fix that too, with a strict diet of cardboard, twigs and gravel.

Thinking Back

I frequently think back to when it all started. I think back to all of the things that I had done to my body when I was younger, things that I won’t mention here. But I can’t help but wonder if all of the power drinking (and other stuff) that I did in college and with friends later on had an effect on my kidney and liver function later in life. All of the fried and fatty foods, the hot dog and pie eating contests, eating whole pizzas with everything on it…it was fun back then. My mother would tell me “you need to quit doing that stuff to your body! Someday you’ll regret all of this!”

But who listens to mom when they’re having the time of their life?

You were right, mom. I should have listened. Now it’s time to listen to Carla, my wife.