Gout: The Rich Man's Disease
What Is Gout
As I mentioned gout is a form of arthritis. There are over 100 different forms of arthritis that affect people every year. It is estimated that somewhere between 1 and 2% of Western society suffers from gout.
Gout is caused by a build up of Uric Acid Crystals (as shown in image) in a joint. These crystals literally tear at the muscle and joints themselves causing extreme pain.
Learn More about Gout
This is a great resource for learning all about gout.
What Causes Gout
Many people will tell you that gout is caused primarily from diet and thus can be controlled by diet. But the fact is only 12% of cases seem to have any link to diet at all. While dietary changes are recommended to reduce Uric Acid in the system there is no conclusive study that links changes to diets to positive results in gout.
The simple fact is there is no simple cause of gout. It could be caused by lifestyle (diet), genetics, medical conditions, or even certain medications such as diuretics. What is known is that gout is usually caused by a build up of Uric Acid, this is called Hyperuricemia, however in some cases of gout hyperuicemia has not been found during diagnosis, and yet there is still a build up of uric acid crystals in the joint. I was such a case, while my uric acid levels were slightly higher than normal, it was still below the level normally associated with hyperuricemia and did not fit with the severity nor the chronic nature of my gout pain.
Oh The Irony
When I was first diagnosed with Gout it became quite the source of amusement amongst my friends and family. No they are not really all that callous, it wasn’t my pain they found amusing, but rather the fact I had gout at all. Gout has quite the interesting history you see, especially during the medieval time period where it was known as “The King’s Disease” or “The Rich Man’s Disease” it was believed it came from eating rich foods and too much red meat, there is some merit to this thought of course, but not much. Men such as Henery VIII, King George IV, Benjamin Disraeli, and Benjamin Franklin all suffered from gout.
The reason my friends and family thought me suffering from gout was amusing was due to my main pastime, historical re-enacting (specifically medieval re-enacting). My step mother went so far as to tell me “You don’t have to take historical accuracy that seriously”. Thus my gout became the butt of many a joke. Naturally all the ribbing was carefully made when I was not in active flair up.
My Story of Life With Gout
In 2010 I was diagnosed with Chronic Gout, nothing about my case fit the normal gout cases though, for several months I was reduced to walking with a cane, when I could stand up at all. There were times during the worst flair up that a gentle breeze blowing over my toe would be enough to have me crying out in agony.
It began one morning when I woke up for work, swung out of bed stood up then immediately fell down in absolute agony, my right toe felt like I was standing on a knife. Eventually the pain subsided, and while it troubled me for the rest of the day by days end it was gone. I dismissed it as nothing major and did not seek medical advice, I should have gone to a doctor immediately.
A few months later the same thing happened, only this time the pain didn’t go away for a couple of days. I made an appointment to see my doctor but cancelled when the pain vanished as quickly as it appeared. The third time it happened it lasted a week, and I hobbled my way into the doctors office, the doctor took one look at me and asked “how long have you had gout” I replied that as far as I know I didn’t have gout. My doctor prescribed some pain pills and ordered some blood tests. The tests were inconclusive, and the pain went away, but not for long, less than a week later I was in pain again, this time unlike anything else I had experienced.
I have broken bones, various degrees of burns, and generally injured myself in just about every way imaginable (I am a very clumsy individual) but nothing compared to the pain of a full blown gout attack. The first time I had an attack it felt like I was standing on a knifes point, but this attack was more, much more than that. Imagine if you can thousands of tiny razor blades imbedded in your toe every minor movement causes it to slice into the nerves and muscle surrounding it, and with every movement more tiny blades crop up causing your toe to swell and the skin to stretch painfully. If you can imagine that, well then you know a bit about what if feels like to suffer from gout pain, but even this does not quite describe the pain. This attack was even worse because it wasn’t just my toe, three joints simultaneously one in my left toe, my right ankle, and my left knee, all exploding with pain.
It got so bad I was completely unable to care for myself. I had to have help to make it the handful of steps to the bathroom from the living-room couch I was now occupying 24/7, and if no one was handy (as occurred one day) I would army crawl along the floor being careful not to let any affected limb touch anything at all, then grit and prepare for the pain as I slung myself onto the toilet, then remained there for several hours until my girlfriend returned from work to assist me back to my couch. Without her help during this time I am not sure what I would have done, every action was agony, walking was impossible, sleep was kept at bay, the strongest of pain meds served only to slightly dull my senses and thus take the edge off.
The doctor was no help, all the texts said a standard gout attack should pass after a couple of days, a week at the most, but week by week the pain remained, then weeks became months and the doctor started to worry, I was on a cocktail of pain meds, and while she knew the drug that would keep the gout at bay all conventional wisdom insisted you wait until the gout flair cleared before beginning taking the drug as it would cause a uric acid imbalance of the start and possibly cause a worse flair up. In the end I was referred to a pain clinic. The doctor prescribed an even more complex cocktail of pain meds and Allopurinol, the aforementioned drug to keep gout at bay.
Apparently in extreme cases gout was so chronic that there was no break in between flair ups and could continue indefinitely, but even that was fairly unlikely in my case since it usually only happened to people who had been dealing with gout for several years untreated, the gout basically just got worse and worse. The pain specialist (how and why does one select pain as their medical speciality, seems a little S&M to me?) thought that perhaps I did not have gout at all, but rather pseudo-gout a similar affliction caused by calcium pyrophosphate crystals instead of uric acid crystals, and since my blood test did not show a high enough level of uric acid to explain the severity of my attacks it made sense.
The problem was though the test that would determine if it was gout or pseudo-gout required I go off all pain meds and allow the full brunt of the attack to resume, then they use a needle to poke at the extremely aggravated joint and extract some fluid to look at the crystals under a microscope which would identify what we were dealing with. The alternative was to just go on the drugs prescribed, allopurinol would not have any affect on pseudo-gout at all it would only combat gout. Guess which choice I made. Allopurinol did the trick and no further testing was required.
How The Treatment Made Things Worse
One of the most common treatments of gout is to prescribe NSAID, non-steroidal anti-inflammatory drugs (aspirin is a NSAID). In most cases this reduces the swelling caused by inflammation and relieves most of the pain of a flair up. My doctor did just that, she’s on the ball and is pretty good about prescribing the right medication for the right symptoms. Of course, since I am me and love to play a fun game called “stump the doctor” NSAIDs were not for me. You see I have another medical condition (we can’t have just one now can we) called acid reflux. Acid reflux is a build up of extra stomach acid that if untreated can cause ulcers and throat cancer. Apparently my acid reflux had caused a small ulcer, and ulcers and NSAIDs don’t mix, as I can attest.
I woke up one evening late at night with severe heart burn, I went to the bathroom and vomited, but it wasn’t just bile coming up, it was blood, and a fair amount of it. I was rushed to the ER and told under no circumstances am I ever to use NSAIDs again. So it became a game of mix the pain meds until the effects of NSAIDs were met without the bloody vomit.
I have not had a gout flair up in a very long time now and I owe it all to allopuinol. As long as I take the drug every day I remain flairup free. Miss a day or two though and the twinges return. There are of course side effects to the drug, but I have luckily not experienced any at all.
One of the claims many people with gout make is that cherry extract works great for keeping gout attacks at bay and reducing the severity of gout. I personally had no success, but many do. Cherries supposedly reduce the amount of uric acid in your bloodstream, and since uric acid build up causes gout it should reduce the chances of a flair up and the severity and duration of any gout flair ups.
© 2014 Jeff Johnston