Gout or Something else (Bunion?)

[Sam]

So Ive been eating a low carb high fat high protein diet on and off for years (10 years) loosing and gaining weight. I am now 31 , Male, no health problems.

In the last 2-3 months I’ve been stressed been drinking 2-3 shots of Vodka or Whiskey almost everynight and eating fats and meats and cheeses. I even occasionally would cheat and eat say 3 cinnabons and lots of sugary stuff. Just generally unhealthy/bad diet for gout.

3 weeks ago went to french restaurant, ate chicken liver and other stuff and drank ALOT. But also, I walked around in the cold for at least an hour drunk/full stomach with very bad uncomfortable dress shoes. I know this because a few weeks ago i wore the same shoes and it hurt my right foot a little bit the day after, and I had barely walked with those shoes. But this time walked ALOT on these bad shoes

Next day my right foot felt sore I could tell its from the shoes. It looks like I have a mild case of bunion.

However 2 nights later I wake up middle of night as per usual to go take a leak, i feel my right foot and lower leg tingling sensation, burning a little bit and foot looked slightly swollen compared to left foot, but no redness and no pain to the touch. Definitely Something was up. it didnt hurt to touch the bunion/big toe area where gout usually attacks. I thought it was gout but wasnt sure as the pain got just only a little worse. Then for next few days I was lightly limping trying not to put pressure on the big toe trying to keep it straight. It feels like the muscle of big toe is cramped and hurts to bend the big toe. Must keep it straight and not bend it. Anyways few days of limping then it went away completely and i forgot about it. This was just about 1 month ago.

Last night I woke up middle of the night to go bathroom, again I feel the same symptoms in my right lower leg and foot, tingling, mild burning sensation and again in the same big toe area it look like bunion and swollen a little bit. Again not painful to touch but my big toe feels like muscle is cramped and hurts to bend it. For dinner i Had big salad salty with a good portion of chicken and beef and 2-3 vodka shots. Drank very little water.

So this time I thought for sure is gout. I went to emergency room 430 am , doctor looked at it said not sure if gout or Bunion bc usually with gout so painful you cant even touch the area, he was squeezing the swollen area I didnt really feel any pain, just the normal amount if someone squeezes your foot. He was literally squeezing the bunion/or gouty area but no pain I felt.

Went to another doctor today he said he thinks its gout and prescribed me to get my uric acid checked ( which I did blood test today will get results tomorrow) and prescribed painkiller INDOCIN (Indomethacin) which I didnt take any yet as I don’t feel the pain is that bad. It’s just a dull aching slightly swollen pain.

Can there be such a thing as mild gout attack not a typical full attack? Maybe both times this happened was mild gout attack. That’s what the doctor said. He said even you check your uric acid now it will be low bc already you got attack so already it deposited the uric crystals out of your bloodstream. Not sure!

I hope its bunion and not gout. When I look at both my feet, i can tell the right foot looks like it has a bit of bunion compared with left. But its too much coincidence I get the attack after eating really bad. In between the 2 episodes of this like zero pain or anything I completely forgot. There was no lingering from the first time it happened.

And it really feels like there a bone protruding from the base of my big toe in the same typical fashion of bunion. But not that big but it definitely is a bump very hard like a bone. SO not sure what this is.

Appreciate your inputs!!!

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Does your big toe have gout, bunion, or both?

[nobody]

Hi!

Indo isn’t a painkiller but an anti-inflammatory. It reduces swelling. Now that often also reduces pain but you might want to take it even if you don’t feel any pain. It’s a fairly dangerous drug so I don’t want to encourage you to abuse it but it’s mainly prolonged use which is risky.
Trying to walk on a swollen foot is also a bit risky so there’s a balance to strike. Also, taking the drug for a couple of days and writing down the effects on your foot may help with the diagnosis.

There is such a thing as mild attacks, only what you describe doesn’t sound very much like gout to me. But every case is different. I guess you’ll have to wait and see what your doctors have to say. The result of your uric acid test may be a strong clue, though you may want to repeat it in a month or two.
If it’s gout, it’ll likely get worse before long. At that point, it should look more obviously like gout.

[Ucatsexas .]

I just came across this thread and decided to jump in. May or may not be useful. Prior to knowing I had gout, I had pain in foot that I thought was my bunion growing as I’d had pain before in the area. I was going for physical therapy for an unrelated reason and mentioned it to my PT who kind of laughed and said bones grow very slowly. She suggested gout. Came to GoutPal and read everything I could. The pain was excruciating so I went to doc. UA blood test confirmed with an 8.6 UA result. I went on Allopurinol. This was 8 weeks ago. He put me on Uloric, 40mg and Dicofenac, 75 mg. Going for another blood test later this week.

I’d love feedback on what you think about this regimen

Hope it helps someone.

[nobody]

Diclofenac and Uloric work for lots of people. Whether they work for you or not is another matter. And the dosage must be right.
Your blood test will tell if the Uloric dose is right and might also show that your body isn’t coping well with one or both of these drugs.
And what the blood test won’t tell, you should already know: are you feeling any side effects? Has your diclofeac dose prevented gout pain?

[Ucatsexas .]

An update: Since March 2918, UA levels down to 5.9 from 9.4 (I thought it was 8.6). So I’m happy. Doc took me off Declofenac because he thinks this has caused creatinine to worsen (no further explanation). I’ll continu with Uloric 40mg for now with another test in a month.

[nobody]

Make sure you have an alternative to diclofenac on hand if you can’t take that anymore. You just started treatment so you may find yourself in need of a drug than can control a serious attack.
5.9 is not ideal. Hopefully, your UA will test lower next time. If not, ask your doctor whether you could take a bit more (not twice as much!) Uloric.

[Ucatsexas .]

What are good gout pain meds? Besides declofenac?

Many thanks for your informed info and support. I’m determined to fight this!

[nobody]

Many gout meds are similar enough to diclofenac that I can’t recommend them if you don’t know exactly why your doctor told you to stop taking diclofenac. I was hoping you were still allowed to take it on occasion, just not every day…
If you were told not to take any diclofenac, I’d look into colchicine and methylprednisolone (or similar) which are quite different. I’m only saying “look into” because these drugs could potentially be hard on your kidneys as well.
If you wouldn’t know what to do if your foot started swelling and hurting real bad, best see a doctor and ask them what you should do in an emergency. This could happen in the middle of the night and you don’t want to have to wait in the ER when you are in such pain (assuming you are well enough get to the ER).

[Ucatsexas .]

Doc took me off diclofenac because he thinks it is causing a problem with my creatinine. I’ll ask for more details, like numbers etc

[Heine]

Hi Sam. I have had almost the same scenario as you explain. 2 days of a little limp and pain and then boom in the middle of the night throbbing pain and could not sleep. 34yo.My blood test showed normal uric acid but the doctor still said gout. Did you find out what you had?

Thanks,

Heine

[Keith Taylor]

It seems to me like you’re lucky to have one of the few doctors who understand that “normal uric acid” is a statistical measurement. Which only shows that statistically, some people will get gout.
Medically, any level above 6.8 mg/dL is hyperuricemia or “excess uric acid”. But a good doctor also knows that uric acid levels in the blood often drop during an attack. Because some uric acid has crystallized out of solution. (as Sam noted).

There are other factors that affect individual abilities to form crystals. Also, people react differently to crystals. So the only way forward is to agree a safe uric acid level with your doctor. Personally, I aim for under 5 mg/dL. Others prefer 6 mg/dL. But the important point is to agree that safe level. Then gradually reduce uric acid to your personal target and maintain it there.

If symptoms have gone after six months (maybe longer if you’ve had untreated hyperuricemia for many years), then it was uncontrolled gout. Which then becomes controlled gout – allowing you the freedom to live a normal life.

Actually, it’s a “better than normal” life.

[Keith Taylor]

I’ve just noticed you also created a new topic about this.

For clarity, my 6.8 mg/dL is 400 μmol/L. So, you’re slightly below this.

I would highly recommend that you start a personal journal of uric acid test results. Hopefully, you can get historic results from your doctor. Then you can start to take control. If your 377 μmol/L is your first result, I recommend a second test when you are free from symptoms.

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