This week has been one of the most painful weeks I can recall. Physical pain, not emotional. It started out a week ago this morning at 5 AM. Well, it actually started out a bit before that. I have arthritis in a few joints, and this is one that bothers me now and then: my left big toe at the ball of my foot (first metatarsal). While my right foot has almost full range of motion, and I can kneel on my right knee with my toe at about 90 degrees, my left toe only bends up about 10 to 20 degrees. It had started bothering me last week, and since I've been through this for years and even have different sandals to wear depending on how painful the day is being, I just switched shoes and limped a bit.
Last Friday night, I was telling Mrs. Graybeard about it and she asked what kind of range of motion I had. Naturally, I demonstrated the small range of motion. Equally naturally, this hurt a bit, but I mean everyone rubs a sore joint from time to time, right? Thought nothing of it. Saturday morning at 5 it woke me up with a level of pain I'd never had. Literally the sheet touching it was excruciating. (Right now, some of you are nodding in recognition and saying a certain word to yourself).
It took me gobbling ibuprofen and watching that have no effect until Tuesday when I said, "uncle" and called my GP to make sure I could get in. He took one look at my left foot and said one word, gout. Well, actually, he said, "gouch", which is as apt a word as any. It's a remarkably painful condition.
Doc is nothing if not empathic, and started me on some potent prescriptions to get it under control: prescription steroids to reduce the swelling in the foot (which had gotten so bad I didn't have any sandals or slippers or anything that fit), and Tylenol 3 for the pain. He also sent me for a blood test to see what my uric acid level was like, and gave me two expected prescriptions for managing this into the future.
Some of you have been through this and have a pretty good idea what the last week has been like. For the rest, gout attacks like this are caused by uric acid crystals that precipitate in the joint. While it used to be thought that gout came from "rich foods", it actually comes from a defect in what's called purine metabolism. Since purines are a component of all DNA and RNA, it means any tissue, plant or animal, is a source. That's right, lettuce is as much a threat as bacon. There's not much you can do for it from a dietary or self-help standpoint. One website said something semi-witty like, "we say to keep off it and keep the foot up, but we find that people aren't very anxious to do anything but that".
Probably, I broke some of the acid crystals while moving my toe in the demo Friday night, and ended up with what feels like ground glass in the joint. It has been essentially impossible to get around the house, which is doubly bad because due to the effects of the Tylenol III, I've needed to run to the bathroom approximately every 27 milliseconds All Day Long. Which tells you how much uninterrupted sleep I've had since Tuesday.
It has been a thoroughly unpleasant week.
Very sorry to hear about this, Graybeard. I hope you can find some way through it (crosses fingers).
ReplyDeleteOh, man...that sux!
ReplyDeleteI have some pain in the same toe, but my blood tests came back negative for gout.
My Doctor is jjst writing it off as arthritis, which runs in my family....
I get excruciating pain in my left big toe (hallux) frequently during the day and night due to nerve pain (bad back). It seldom lasts more than 20 or 30 seconds, but sometimes it repeats right away. No narcotic pain medications have any effect upon it, because it is pain from damage in the central nervous system (neuralgia), in the lumbar spine.
ReplyDeleteThe only medication that works (for me) for that sort of nerve pain is gabapentin. It is actually an anti-epileptic medication (originally created to reduce the occurrence of seizures). Years ago I had issues with two cranial nerves causing extremely intense pain. These neuralgias were treated with Tegretol (carbamazepine), an older anti-epileptic. It worked, but interfered with normal brain function (slow thinking, poor memory, etc.). I finally had surgery which cured the two neuralgias (glosso-pharyngeal neuralgia and trigeminal neuralgia).
Gabapentin (brand name version is called Neurontin) works better for me than the Tegretol, without the mental deficits I experienced on that med. It has helped quite a bit with the nerve pain I get in that toe and occasionally elsewhere on both legs.
I realize it would not help with gout, but if you should develop a neuralgia due to arthritic changes in your spine (as did I), consider discussing it with your doctor, if he doesn't bring it up himself.
Hey SiMan, hope you are feeling well real soon. Amazing how something like a toe can make us realize how our peace of mind is dependent on all the little things we take for granted every day. Of course with things like arthur-itis, more like the body is reminding us of all the things we used to do with those parts, used and abused.
ReplyDeleteBen there done that including the gravel in the joints feeling
ReplyDeleteFor me I was able to eliminate the problem with a change in diet, specifically cutting out chicken. and i know it really is the problem because if i have chicken more then once a month the gout is back. It has been over a year since my last problem now.
Having talked with others suffering from gout it seams that different people have different triggers so my suggestion is to try cutting different things out of your diet and see if it has an effect.
As a note my symptoms have a lag time of nearly a week from food intake to symptom change, both starting and ending
Now that's interesting! One of the things you encounter in the "rich foods" hypothesis is to cut out the pork and especially bacon. Chicken is a far larger percentage of my diet than pork or bacon - not that I avoid them. With the one week lead time, unless you got lucky, that must have been hell to find.
DeleteSince it's my first attack, I have no idea what triggered it. I know that I have three pairs of "around the house" sandals or slippers, and two of them were chosen to get around compression of that toe joint. Maybe I've been on the borderline of having a flare up for years and just now hit whatever combination it took to cause it.
Gout tends to be genetic. My father had it and sure enough I have it. For years I would get it where it was a sharp pain like a needle inserted between the joints in my big toe. Worse at night and when I first walk after sitting or lying down. But a month ago it decided to go full blown and I mean swollen, hot, and so painful it would bring tears to my eyes to just touch it. Range of motion? NONE. putting on a sock would make a grown man cry. The doctors gave me medicine and the swelling is gone (mostly) the pain is a mere 3 or 4 now and I can walk with a slight limp (to keep the big toe from flexing). The first time I ever heard of gout was in the early 50's in a scrooge McDuck comic. Now I am in the comic.
ReplyDeleteAs for chicken, I'm just not sure about that. It's genetic. Certainly their is a diet component but the science says alcohol and organ meats not chicken. If you are serious about dealing with the gout don't get sidetracked by people with a dietetic agenda.
Range of motion? NONE. putting on a sock would make a grown man cry. Until I went through that very thing, I wouldn't have understood. Today, I do.
DeleteI've never had anything like this. I originally noticed losing flexibility in that toe years ago. I just assumed it was "plain old" osteoarthritis. Some days it was more stiff and sore than other days, just like all the other arthritic joints I have. The experience made me wonder if that toe has been accumulating more and fewer uric acid crystals for years? It would make sense when I try to figure why shoes would fit some days and hurt others. Some days it hurt more because my shoes really did fit differently those days.
I have no dietary agenda, but I do notice a correlation for my flareups with eating shellfish, particularly shrimp.
ReplyDeleteProlonged mild dehydration also seems to be a factor for me.
I've found B vitamins to be helpful with leg and foot pain in general, as I sometimes suffer from neuropathy.
http://www.medicalnewstoday.com/articles/147963.php
The treatments listed include the drugs mentioned in the comment above.
nick
I don't read dietary agendas into what anyone is saying (unless they go on an obvious rant about being vegan or something), so no worries there. I didn't read that into the comment about chicken either. We're just folks talking about what we see work for us.
DeleteThat said, mild dehydration was the first thing my GP suggested. He knows I'm trying to lose weight and keep my carb intake low - as he recommends. One issue with low carb diets can be dehydration. I think he mentioned vitamin C might help clear uric acid, although I might have read that.
I gotta tell ya, though, my inner statistics geek is going nuts over data collection experiments to make sense of this! The thing is, if I never have another gout flare (which would really be what I prefer), no amount of statistics would work.
Sympathies, sir. I've been there and it is no fun. There are reports that cherries, be they sour, sweet, juice, fresh, frozen or even extract from your nutrients store can help. I never saw much effect but my attacks are mercifully rare. Praise and thanks to the responsible entities.
DeleteJimbowb.
My comment on dietary agendas is not to disparage anyone. Since Gout is affected by certain foods diet is a legitimate concern. But... It always seems that no matter what the problem the naturopaths, the pro-vitamin/supplement people come out of the woodwork. I fully expect someone to suggest taking turmeric (which is the latest fad supplement) or insist it's caused by HFCS or just plain sugar (both of which are popular villains for the food nuts). I could go on about all the various witch doctor cures out there. My concern is with gout time is not on your side. If your foot swells up you are causing tissue damage to good tissue (that not affected by the actual gout) and when the swelling goes down and the gout is under control (presumably by a doctors prescription) you will still have pain and damage that might last for awhile. So you don't want to be experimenting with not eating chicken or taking vitamin C or whatever.
ReplyDeleteI surely wish I knew what would really work other than the prescription but I don't and the doctor doesn't. The foods that can cause it are organ meats and alcohol. The superstition 30 plus years ago when my dad was suffering with it was any "expensive" food because the general belief was that gout was the curse of the rich and the common man eating more common food didn't get it. Well, I'm not rich and I don't eat expensive food so I'm not sure that's the problem. So I really would like to know what might work BUT I choose not to listen as soon as someone says take mega-vitamins or don't eat meat or eat this berry they just discovered in the jungle, etc. If my doctor started talking like that I would change doctors.
We're in complete agreement; I'm also quite sick of the idea that "if we just eat the one magic food nothing will ever go wrong!" I will stick with the prescriptions my GP gave me. They have dozens of years of use behind them and are the best we know.
DeleteSo, every year we go to Zion and the Grand Canyon for a few weeks. Love it there, the wonder the great outdoors, the hiking. Yes I am 72 and have gout and am just getting over my most serious bout with gout (rhymes). When I get back in a month or so I hope to be able to say I could still hike the five mile round trip up 3500 feet to Scout's Lookout and many of the other great hikes. Lots of walking, last year we hiked 110 miles in two weeks (not counting the walking from here and there to just get to places). I admit I'm worried, my foot hurts even though the swelling is mostly gone. But I'm hopeful that I will still be able to enjoy something I love. I'm still taking my medication (colchicine) and will wait until I get back from my trip to try to wean myself off of it. I will let you know how it all went.
DeleteSir: I know that this commentis regarding a stale post on your blog, but my experience with occasional gout is that it is always traced back to my rare hard liquor consumption, specifically vodka as in the bloody mary type.[Yummm]. A much missed friend of mine could not resist occasional split pea soup at a favorite café which ALWAYS sucker punched him for the better part of a week. We pay to play, I guess.......
ReplyDeleteHeal up till next time, Soapweed
Thanks for stopping by. In my case, absolutely no split pea soup OR vodka was involved. I really have no idea what triggered it.
DeleteThankfully it's mostly gone. Some shoes still press on the spot, but it's way better than a week ago today.
Several friends have told me they had a flare up only one time . That would be nice.