After toe injury, MAJOR gout problem

[kiteman]

I had 1 gout attack in my big toe about 2 years ago. Hurt for about 36 hours pretty badly but went away by just taking ibuprofen and drinking water. Had one more attack earlier this year but it was very minor and was reduced to no pain after about 8 hours.

Last Wednesday I tripped and fell down my stairs, bending the gout toe up underneath my foot very extremely. It hurt a bit Wednesday, but by the weekend had almost gone back to normal. Monday I woke up with a huge swollen foot and severe pain, a pain that has increased twofold every 12 hours ever since.

Since Wednesday I have been unable to walk, sleep, or even eat at times. I went to a podiatrist and he gave me a prescription NSAID and I have been taking that and drinking a ton of fluid, including some baking soda treatment. I have had fever as high as 101, headaches, muscle spasms, and generally I feel like I have a cold plus a knife stabbed in my toe at all times. The doctor said extreme gout attacks are common after blunt force injuries to affected joints.

Is this a case of bad luck or is there any hope this will go away soon? At this point there seems to be no end in sight as even the NSAID is really not holding much pain back. Thanks for any help.

[Keith Taylor (GoutPal Admin)]

Go for Pain Freedom immediately. You don’t say what NSAID dose you’re on, but it should be maximum prescription strength. Anti-inflammatories alone are rarely enough for a severe gout attack. Ask your doctor or pharmacist for a pain blocker that is compatible with whatever NSAID you are taking.

This is your final warning to get uric acid down to 5 or below. Your gout is only going to get worse if you do not get uric acid controlled. At the moment, I can understand if you just want to fix your pain, but please don’t start 2014 without uric acid lowering treatment.

[kiteman]

Thanks for the help. I’ve had my uric acid tested three times in the last 2 years, all coming back mostly normal. All of the doctors have said it’s not high enough to be concerned, the gout could be hereditary. Up until the injury all of my attacks have been pretty insignificant, and the injury (my doc told me) is what caused the most recent attack, not an unbelievably elevated uric acid level.

So, I’m not sure I’m at a huge risk yet? It sounds like the injury alone is really what led to this incredibly painful attack.

After over a week, I’m just now starting to come back to life though.

[Keith Taylor (GoutPal Admin)]

If your doctor says uric acid is normal, rather than telling you what the number is, you should find a new doctor, or at least train the one you’ve got.

Uric acid does not need to be “unbelievably elevated” to kill or seriously damage you. It just needs to be over 6.8. That is the maximum level if your joint temperature measures OK (98 F, 37 C). As you get older, joint temperatures tend to drop, so anything over 6 is definitely not safe. Between 5 and 6 is a gray area.

Unless you have other medical problems that cause you to accept the gray area, you must aim for 5 or below.

Having a uric acid level of 9 is not that much different from 7. You might get an extra couple of years, but 7 will still lead to crumbling joints and organ damage. Uric acid crystals will grow every day. Gout attacks will get more frequent, more widespread, and more painful. Why put yourself through that, just because your doctor is misinformed.

Here are the two important points:

1. Normal uric acid is meaningless.
2. After painful gout attacks, comes joint erosion, followed by organ damage from uric acid crystal deposits. Is that what you want?

The gout attack from a toe injury is a profound early warning of painful years ahead. The older you get, the harder it is to cope. Why not fix your gout today?

[Sorry if that sounds like a rant, but my blood boils when I see normal uric acid. Dangerous nonsense, that has damaged more gout patients than anything else.]

[kiteman]

First of all I appreciate you taking out time to write very detailed responses. That being said, I think I’m confused about the concern. I had 2 attacks (1 mild) in 2 years, and my doctor specifically said the most recent (third) bout was due to injuring my toe, and had I not injured the toe, I would not have gotten a gout infection. So I’m just lost as to why I should all of a sudden be concerned for my organs and life? It seems pretty evident that high uric acid level is not the cause of the most recent attack, and being concerned for my organs and life seems a little dire since not everyone who gets gout dies from uric acid poisoning. I’ve seen several doctors regarding gout (internist, podiatrist, primary care) and they’ve all said be careful about your diet but it’s not necessary to take any medication for your gout just yet. Your posts just make my situation sound very extreme so that’s what makes me a little cautious. BTW I left a message for my doctor as to the level. He told me the level but I forget the number.

So what’s the solution? Can you reduce uric acid levels in any way other than taking medicine? I’ve been doing a baking soda treatment, drink black cherry juice daily, and soak my foot in epsom salt/apple cider vinegar 1-2 times a day. From what I’ve read eliminating beer and liver is good but otherwise diet only makes a minor impact to your gout/uric acid level. And also as I recall my doctors have frowned upon me taking things like Allupurinol with my level of uric acid/gout because they believe the side effects to outweigh the pros at this stage. That’s not to say my situation does get more dire in the future, but at the present none of them have made that recommendation.

[Keith Taylor (GoutPal Admin)]

Dear kiteman,

I don’t know you as a person, but you came to me for help and advice. My default setting is that I care. I do not want my fellow humans to suffer needlessly. Personally, I delayed starting uric acid control, and I have caused myself damage. It is not as extreme as some of the situations I have mentioned. I overemphasized the threat of damage because I want you to act now, rather than wait until the threat becomes real.

It is nonsense to say that the only reason for your gout attack is physical injury. The trauma to your toe has triggered the gout attack, but that attack could not have occurred unless your toe was packed with uric acid crystals. Healthy people who stub their toe do not have to endure “a huge swollen foot and severe pain, a pain that has increased twofold every 12 hours ever since. Since Wednesday I have been unable to walk, sleep, or even eat at times.”

The very fact that such severe pain and discomfort has happened to you, tells me you are suffering. There is a history in gout management of offering the choice of uric acid control, or just managing the pain of gout attacks when they happen. Pain control is easy. Uric acid control is quite easy, but takes a bit of effort. Lazy doctors will opt for pain control. Recent understanding of the true dangers of gout mean that pain control alone is not an option after the second attack. But the message has not reached most doctors yet.

I read gout research every day. Many doctors would find this impossible if it interferes with golf plans. They fall back on the outdated gout information they learned years ago in med school.

There is absolutely no doubt that gout is a progressive disease. Left untreated, it will do all the damage to joints and organs that I mentioned earlier. Like a repentant sinner, I realize that I left uric acid control longer than I should have, and I do not want anyone else to suffer. Fortunately, I only caused some joint damage, but I know I put my heart, kidneys and other organs at risk. I delayed treatment, but I know I was wrong to do so. If my doctors had better awareness, I would have been persuaded to start treatment sooner. Instead, I spent years doing gout research, until I knew that the risks meant I had to act. Most doctor do not understand the risks, so you get bad advice.

Simply put, I want you to understand the risks, and decide what to do knowing those risks.

I can help you with dietary advice that might control your gout without pharmaceutical intervention. I’m not prepared to comment on anything in your last paragraph without knowing your uric acid number. It is absolutely impossible to control gout by diet, and other lifestyle changes, without tracking uric acid.

Actually, I will make one comment, as it is not to do with diet. “doctors have frowned upon me taking things like Allopurinol with my level of uric acid/gout because they believe the side effects to outweigh the pros at this stage” is total bullshit. I am prepared to explain why.

Let’s agree to go for dietary control. Without knowing more about you, it is probably the best option. Before I can help you, I need to know what your uric acid number is, full details of what you eat and drink, including any dietary supplements, your height, your weight, your exercise routine. Please take some time to post as much lifestyle info as you can, and I will respond with as much helpful advice as I can. At this stage, as I don’t know your uric acid number, I’m not sure I can fix your gout, but I promise you, I’ll give it my best shot. You can start this with a daily post of everything you ate and drank the preceding day. Add the other info as you get it.

Kindest regards
Keith

PS. Gout is not an infection. Uric acid is not a poison. I’ll try to explain that during our dietary project to fix your gout. Remind me if I forget.

[kiteman]

Doctor called me back and said a year ago the acid level was 9.0, which is really high based on my research this morning. He did not seem concerned at the time until/unless the gout came back. Now it has come back so I think it?s time to revisit the issue. I also have high blood pressure which is odd because I only seem to get it in the doctor?s office. I don?t get as high readings at home, but the doctor still insists I take a small dosage of linisopril. Quite frankly the readings are so mixed in between the two places that doctors aren?t really sure what dosage I should be on if I should be on any at all. I also have moderate OCD but don?t take anything for that.

I don?t eat great, but not really bad either. I do not eat fast food often, maybe once a month. I work from home and usually make sandwiches during lunch and spaghetti/enchiladas or something once a week that I can eat for dinner. I don?t eat a ton of vegetables though if they aren?t in the aforementioned dishes. I eat a lot of macaroni and cheese! I love meat to be in food like enchiladas or sandwiches, but I don?t eat organ meat or seafood very often. It would be hard for me to not eat meat though altogether. How many points can a diet like this really add to your uric acid level?

Beer used to be my alcohol of choice because it?s easy; I never drank wine and rarely liquor. I?ve learned now beer is really really bad for gout, so it looks like I might have to give that up once and for all. I probably drank more beer than I should for a gout sufferer too since I?m still young and my friends like to go out on the weekend. It looks like I?m going to have to make a switch to wine and limit my intake moving forward. How many points can beer really add to your uric acid level?

I?m starting to wonder if my uric acid level is high enough that I need to be on Allopurinol after all? I don?t see how diet alone and cutting out beer can reduce it to a normal level, but I?m not doctor and even if I were there is no guarantee I would know anything anyway, ha. My foot is still a little swollen and tender from last week?s attack, but I don?t think I?m in the gout attack phase anymore since I feel normal and it really doesn?t hurt unless poked around with. If I should be taking medicine, should I start taking it immediately or wait until the pain subsides completely? Thanks again for your concern and input. Gout seems to be a black hole in the medical field?every website and doctor I see has a different opinion.

Last question is after changing diet/eliminating beer, how long before those changes affect uric acid level? 1 week? 2 weeks? 6 months? I am just wondering if I should give my body a chance to reset with some dietary changes before I get my uric acid readings again, that way the doctor can make an assessment of just how much uric acid medicine I need.

[kiteman]

Oh and I just turned 30 and am not overweight at all. Probably underweight in fact. I don’t like exercise but usually walking while playing golf a couple of times a month is about the most strenuous exercise I get. Gout, High BP, and OCD all run in my family, but as far as I know gout is the only one that no one takes medicine for.

[GoutPal HelpDesk]

Gout and Exercise Update

As this topic is popular with gout sufferers who care about exercise, may I direct you to 2 more relevant places?

1. Keith has updated Gout and Exercise to reduce Uric Acid to include new evidence to show that aerobic exercise for 45 days can reduce uric acid.

2. I have grouped new exercise discussions for gout sufferers into the Gout and Exercise Forum. So please join those discussions and add your own questions, experiences, and opinions about exercising with gout.

Please remember if you want personal help with any aspect of gout, the new place to ask is GoutPal’s Gout Forum.

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