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Hello there. I have been reading up on Gout for last 5 hours. Not sure if I have it or it's a false alarm. I am 35years old very active and go gym 3-5 times a week to do weights(45minutes) and cardio (45minutes). I am fit and not fat.
10 days or so ago I felt slight pain or shall I say discomfort on the top part of my left toe (I have marked with a pen, black dot inside the green circle in the attached photo). I did not think much of it. It was more irritating pain rather than what I would call full blown pain. I don't remember hurting my toe recently or ever.
5 days ago it went completely away. Then I was at gym and was using calf muscle machine where you basically push some weights with the ball of your feet, toe does not play any direct part. I did not feel any pain so maybe completely unrelated but next day the irritating pain returned to my toe.
3 days ago I went out to do some shopping and on wearing my shoe I realized that it hurt bit more than before. It hurt enough for me to try and transfer my weight to the outside of the left foot while walking with my shoes on. All through out there has not been any clearcut swelling or redness. Since yesterday maybe there is very slight sweeling and very slight redness. Not sure but you can be the judge.
Now I am back to my initial irritating pain level but will go and visit doctor tomorrow to check it out. At no time ever in the last 10 days did I have any pain outside the green circle area that I have drawn on my foot. Just on the top where the black dot is. I have had full range of movement in my toe during this whole period and definitely no pins and needles sensation. Could it be gout?
Some background- I have been vegetarian for last 7 years and have a very good diet. No junk food etc. Mainly fruits, vegetables and nuts. I do eat lot of cashew nuts 200gms maybe every 2-3 days. I ate lot recently but nothing more than what I have been eating for months and years.
My 70+ year old dad has gout attack sometimes and from what he says the whole foot area hurts even with a slight touch. I don't have that kind of pain. For example right now I have to press with medium force on the black dot to feel the pain. I can walk freely but feel that something is not 100% right inside the green circle.
I tested my urine ph level and it is on the acidic side- ph6 or maybe ph5.
So when I see the doc tomorrow what tests should I ask for? I am just a number for doc so I want to be pro active and get to the bottom of this.
1- Blood test? Which specific tests should I ask for?
2- X-ray?
3- Too early to do the liquid from joint test?
What else? Thanks for any advice and opinion.
1- Blood test? Which specific tests should I ask for?
Uric acid, but it is not conclusive. I.e. above 7 indicates high risk of gout, but below 7 does not exclude gout, as uric acid is lower in the blood if it has crystallized in the joints.
2- X-ray?
Yes – you need to rule out physical damage.
3- Too early to do the liquid from joint test?
No, but you are probably better seeing a rheumatologist for this, as few family doctors have the experience to do it painlessly and assess the results accurately.
Goutpal thanks for the post. I know you are probably not a doc but visually what do you see in my photo apart from my ugly feet? It is possible that it I have Gout 🙁
Regarding the fluid test, don't they make the area numb to be painless?
I have to see the family doc anyway as then he refers me to the specialist, that is how it works here. If I do the joint fluid test then can it 100% confirm if I have or not have gout? Is it not possible that someone has Gout but no crystals at the joint on the actual test day?Edit- For future use is there no home blood uric acid test? Similar to home urine ph test?
Though the swelling is fairly slight, taken together with the fact that your Dad has gout, and it is often hereditary, I'd say there is definite suspicion of gout. Of course, as you surmise, I'm no doctor, so it could be something else.
That is really why I recommend the joint aspiration (arthrocentesis) test – because it should be conclusive. According to Courtney and Doherty (Joint aspiration and injection and synovial fluid analysis):
Joint aspiration/injection and synovial fluid (SF) analysis are both invaluable procedures for the diagnosis and treatment of joint disease. … detection of Synovial Fluid monosodium urate and calcium pyrophosphate dihydrate crystals, even from uninflamed joints during intercritical periods, allow a precise diagnosis of gout and of calcium pyrophosphate crystal-related arthritis (pseudo gout).
So they clearly believe that once crystals get into the joint, they can still be detected after swelling has gone down.
Yes, there is a home blood uric acid test kit available.
I went to the doc today. According to him it is highly unlikely that I have gout. The kind of very localized pain that I have is not very gout like and not as severe as what gout patients suffer. The cause is definitely the joint and not tendons or anything around it. I will get X-rayed today but he thinks it will most probably come out normal as well. Doc thinks I might have overstrained the joint somehow. Fingers crossed. My blood uric acid level was 4.6 or was it 4.9. I forgot now. It's slightly high?
I need a bit more info on that test result. Can you call to get an exact value?
If the result is the conventional mg/dL, then 4.6 or 4.9 does not matter – it aint gout.
However, if the result is some variation on SI units (mmol/dL?), then 4.6 puts you at 7.7 mg/dL – definitely in the high risk group, though not conclusive proof of gout. 4.9 translates to 8.2mg/dL, not far from the “very high risk” count of 9 mg/dL.
GoutPal I am going back in two days with myX-rays and he will be taking my blood urea test again, I will make sure to get all the info that you were refering to.
His words were that normal blood urea is roughly around 4.2 and mine is slightly higher than that (4.6 or 4.9) but no where near the risk area levels. So that would make me believe that it was mg/dL.To be honest I have driven myself into such a state that everything seemed like a blur when I was there. You won't believe how hard I have been working out on my health for last few years and even the possibility of gout was messing with my head. I was like I take so much care of my health and as a reward I get gout. Whatever happens I have a new found respect for gout sufferers. I will be buying the home kit that you mentioned earlier so I can keep a close eye on my blood uric acid levels, irrespective of being or not being diagnosed with gout.
One of my great difficulties, probably natural on a site that is dedicated to gout, is the issue of giving gouty advice to someone who hasn't got gout. Once the idea is there, it is hard not to see the situation as gout looking for recognition and treatment. Perhaps if we had better local diagnostic centres (for all common diseases) and fewer managers who need waiting lists to manage, we would get the answers we need much earlier (A bit of a UK slant, but I know that prompt, accurate gout diagnosis is an issue everywhere, despite different health administration models).
Just as an aside, have you noticed that the more that professionals seek to display their professionalism, the worse service we get? Doctors want to be doctors more than they want to heal, and so our health suffers. Teachers want to be teachers more than they want to educate, and so our education suffers. And don't let me start on politicians (or rather DO let me start on politicians). Sorry, rant over.
For your sake, I hope that you have not got gout, but part of me will regret losing a great contributor – especially one that gives us pictures!
Best of luck with the x-rays.
Let me add my $.02. Probably lots of overlap on previous posts.
Firstly,
You are very thorough VegGuy…and your little feet are kinda cute.
Secondly, I weigh in with a strong NOT gout for several reasons primarily the location of the pain on the top of the bunion joint rather than the WHOLE bunion joint with empasis on the MIDDLE/body center of the joint. THough I can see some slight rednness and swelling, the PURPLE of a podagra attack is not apparent. Add to that the low serum uric acid and the fact of your vegetarian diet.
X-rays: with a huge massive attack the best you see is a bit of fuzziness around the joint until such time as the joint is somewhat destroyed. X-rays will confirm nothing.
Now, what is it? You state that the toe is not involved in calf raises…that is dead wrong. THe bend of the foot is precisely the bend of the bunion joint which is where the true Hell of gout usually manifests. This joint IS the innermost part of the “ball” of the foot. A calf raise demand a strong pull on the tendom atop the bunion joint and that is precisely where your pain is.
So my Dx is tendonitis of the foot, and precisely the “tensor hallicus longus” (I had to look that one up so don't be impressed.
) and my Rx would be to lay off the calf raises for a month or so. Alleve (naproxen) or ibuprofen will probably help with any pain.(I stand warned about too many calf raises…I do them but not a whole lot becasue they are hateful and show so little results.
)zip2play said:
So my Dx is tendonitis of the foot, and precisely the “tensor hallicus longus” (I had to look that one up so don't be impressed.
)
Well, I AM impressed
Well…there's another way to diagnose it: Tuff it out this time and if it's Gout; IT WILL RETURN….probably about a year or so from now when you have completely forgotten about the first incident. Sorry…thats my tongue in cheek humor.
Good luck…I really hope it's stress or strain from the gym!!!! If not, life isn't over….you just have to ride out a 'toe party' (my name for it) now and then!!! It can be an reason to get the wife to bring you stuff while you watch TV with your foot up on a pillow. Don't let her breach the 'Do Not Cross' tape making a 3 foot perimeter around your foot though. I have two bouncy 7 and 10 year old kids that love nothing more than to jump and bump my sore toe!!!! I'm in the process of constructing a titanium metal box to encase the foot for these occurances.
I hope you all appreciate the humor. I've had diagnosed Gout for 9 years and I still live a happy life. Remember, there are millions of people fighting life threatening diseases at this very moment…Gout is not one of them…glass half full!!!
Take care…..
You lot are funny
So I went for the x-ray today. Half way through, the machine broke down LOL So I was sent to another place to get them done (they payed for the taxi). Stripping off twice at two different MRI places was too much for me Anyway I have the x-rays but have to wait till friday to show them to my doc. To my untrained eye the xray does not seem to show anything bad. I compared them to normal x-rays online. Wearing and walking in my shoe is not as painful as it was before, just bit stiff. When I press the black dot with my finger then the pain is exactly same as before though.I was not doing calf raise. It is a machine for the calf but you push with the lower front part of your feet (not the toe) and rotate with your ankle area. I think it migth still have been the culprit. Once I get better I won't use it for few months.
http://www.reccenter.siu.edu/w…..d_Calf.jpg
Doc did a thorough check of my tendons and tendons don't seem to be the problem. You know he made me push up, down and sideways with the toe and it does not hurt at all, meaning the tendons are ok. The pain is joint related. I might have over driven them without knowing.
Edit- You guys any good at reading X-rays?
CC_Alaska said:
Don't let her breach the 'Do Not Cross' tape making a 3 foot perimeter around your foot though. I have two bouncy 7 and 10 year old kids that love nothing more than to jump and bump my sore toe!!!! I'm in the process of constructing a titanium metal box to encase the foot for these occurances.
Make it bigger. Put the kids in.
GoutPal said:
Make it bigger. Put the kids in.
Better still don't have any parasites, umm I mean kids
CC_Alaska said:
Well…there's another way to diagnose it: Tuff it out this time and if it's Gout; IT WILL RETURN….probably about a year or so from now when you have completely forgotten about the first incident. Sorry…thats my tongue in cheek humor.
Oh you are evil
You might be on to something as I feel that I have had this pain before for past few years. A minor version of it. It's like a deja vu feeling. Maybe I am just going mad 
vegetarianGuy said:
… Maybe I am just going mad
Then, my friend, you are definitely in the right place
Update- Pain is less (not that it was ever extreme) but when I press my toe with my finger then it's still there. Today I even felt slight tingly, electric kind of sensation on the underside of my toe, could be related or just one of those random things. Anyway saw the doc today with my x-rays. X-rays are ok, so no physical damage. Doc took the blood reading again and said he is confident that I don't have gout.
– Pain in not the kind that gout sufferers have as I can walk freely plus touching does not hurt (I am thinking maybe because I am at very early stage so pain is low level?)
– Urea reading is normal (Gout Pal's link says otherwise)
– Visually it does not look like gout (Again maybe because I am at very early stage?)
-X-ray shows all clear (Again too early for X-ray to show anything)
I was pleased and excited but I asked for copy of my readings.
On coming home and analyzing the reading I feel I am not out of jail! My reading as stated in my earlier post was not 4.6 or 4.9 mg/dL like I had thought. My blood urea level when I first went to doc last week was 495 µmol/L and today was 429 µmol/L. I also have a reading from 2007 in my chart which was 455 µmol/L.
Based on GoutPal's link I am in the “BAD” category- https://gout-pal.com/refere…..id-levels/
Feel like I am at square one again? Whether I actually have gout or not currently I don't know. The point is that I might as well act as if I already have
What the hell am I going to do with my diet? I eat so sensibly already and have been for last 5 years 
I work hard in the gym and am very fit and not overweight.What should be my next step? I will order the blood urea test kit tonight to monitor everything. Should I see a Rheumatologist or see how it goes for next few weeks and months? Am I being paranoid?
EDIT- Googling and came to this link-
http://knol.google.com/k/theod…..locale=en#
Depressing those photos. I think I am going to bed to shut down my mind for now.
There are different figures given for the saturation point of uric acid. This can also be raised by higher pH and higher temperature. The figure quoted by Roddy and colleagues in “Concordance of the management of chronic gout in a UK primary-care population with the EULAR gout recommendations” is 360 µmol/L. I have seen it elsewhere as high as 400. I can find no evidence to suggest that readings in the 429 to 495 range are anything other than a risk for gout, so where your doctors confidence is coming from is beyond me.
Gout is often hereditary, so that is a a second pointer to suspect gout
That is not to say that you definitely have gout, but you must be a candidate for the joint aspiration test.
I have been in a similar situation. Unfortunately (or perhaps luckily), I was in no position to walk out of the x-ray department, so they had to continue testing until they found the gouty culprit.
Your lifestyle is probably helping to inhibit the full effects of gout. However, if you are genetically programmed for excess uric acid (either as an under-excreter or over-producer) then diet may not be enough. And even vegetarian diets may not be gout optimal. Are you taking supplements? Excess iron can be a real gout trigger. And do not forget that you are surrounded by the meatiest source of uric acid – your own body. In fact one of my criticisms of the “pathway to from purines to uric acid” model from the Google knol that you refer to is the equal weight it gives to food intake and cel breakdown as sources of purine. The former should be tiny print, almost invisible, whilst the cell breakdown emphasis should be large enough to cover the whole diagram. Increasing muscle mass through excessive exvercise is not good for gout, though you have to balance the cardio-vascular risks of too little exercise.
If I were you, I'd see a rheumatologist.
Are you taking supplements?
I take Berocca on and off. Nothing else apart from that. Try to get everything from natural food in general. Do you think I should stop taking Berocca? It must have artificial sweetener or something in it.
GoutPal what do you make of my reading spiking to 490s during the pain and lowering to 420s as the pain has eased. Should it not be other way round? Urea near the joint so reading lower during pain?
> Increasing muscle mass through excessive exercise is not good for gout, though you have to balance the cardio-vascular risks of too little exercise.
I am not body builder or anything like that
I don't take any protein shakes or suppliments either to get big. I just go gym to do mid level weights for an hour and step machine for 40 minutes of cardio. This gout business has really thrown a spanner in my works. I don't even know what to do, what not to do and how to balance everything. I guess best would be to take regular blood urea readings and see how my diet or change of gym routine impacts my readings.Yes I will see a Rheumatologist. Are they the absolute specialists for Gout or is there a chance that they are not too bright?
Are Arctic Medical's urea readings reasonably accurate?
I am on Arctic Medical's website but not sure about the lancet bit. Does their lancets 30G (100) box have everything in it to draw blood or do I need a holder/pen type of device to hold the lanceot?
http://arcticmedical.co.uk/con…..ancets.png
P.S- I have your GPAM8 code on the ready.
P.S II- Thanks for all the help and patience for my 1million questions.
The holder (it's actually called a lancing device!) is included with the meter, but you only get 5 lancets, so best to get a box with your order.
Come to think of it, lancing device is probably better than pricker!
vegetarianGuy said:
Do you think I should stop taking Berocca?
Gout pal what do you make of my reading spiking to 490s during the pain and lowering to 420s as the pain has eased. Should it not be other way round? Urea near the joint so reading lower during pain?
I am not body builder or anything like that
I don't take any protein shakes or suppliments either to get big.Yes I will see a Rheumatologist. Are they the absolute specialists for Gout or is there a chance that they are not too bright?
Are Arctic Medical's urea readings reasonably accurate?
I was worried about too much iron, but it is not in Berocca, so you should be OK.
Uric acid readings do fluctuate, so I would not read too much into it from 3 readings. The tendency for uric acid in the blood to go down when crystals form is common, but not absolute. By the way uric acid [C5H4N4O3] is not the same as urea [CO(NH2)2]
I'll stop looking out for you on Worlds Strongest Man
I can't attest to individual brightness, but yes – rheumatologists are the gout specialists. They also deal with other inflammatory diseases, so should be in the best position to distinguish gout from other diseases.
The uric acid meters have been shown to be very accurate compared to full size lab machines. The only problem is getting the test right. Only two simple reminders:
- Wash and dry hands before use.
- Make sure the drop of blood is large enough to fill the circle on the test strip.
Ok ordered the Arctic stuff and picked goutPal from the drop down menu. Looking forward to testing and keeping a log of the read outs. Also searching for decent Rheumatologist in my region.
My doc did say that as I dont have major swelling getting fluid out of my toe joint won't be a simple thing. Any views on that? Will it be super painful?
Granny Smith and similar sharp tasting apples, peas, plain non salted cashew nuts, various beans and lentils, spinach and leafy dark greens have been very very very central part of my vegetarian diet. Based on sucking up info from all over the web it seems Peas, Cashew nuts, beans and lentils are a no no for me. This will really impact my vegetarian diet. Hmmm don't know what to believe as there is so much contradictory info everywhere.
vegetarianGuy said:
My doc did say that as I dont have major swelling getting fluid out of my toe joint won't be a simple thing. Any views on that? Will it be super painful?
Based on sucking up info from all over the web it seems Peas, Cashew nuts, beans and lentils are a no no for me.
As you know, I am not a doctor, but I simply cannot see how inflammation makes joint aspiration easier. Synovial fluid occurs naturally in the joint – it is not the result of gout, but something everyone has. (forgive me if there is some disease that causes people to lose synovial fluid – as a layman, I assume everyone has it). In my experience, the procedure is painless – I was still waiting for it to happen when the doctor had finished.
I believe that this should be done by a rheumatologist, but I appreciate the difficulty of this if your doctor will not refer you. I can think of 3 options, and I hope others will chip in (but please remember this is a UK situation where seeing an administrator is at least one thousand times easier than seeing a specialist):
- Ring NHS Direct for advice (I have never tried this)
- Join BUPA or similar private health scheme (I have never tried this)
- Feign agony and job-threatening inability to walk at the nearest hospital (I wasn't faking)
The danger of “sucking up info from all over the web” is similar to drinking from the toilet bowl when parched. Yes, you will quench your thirst, but you also risk sucking up the shit.
Perhaps I should make my warnings clearer in “Foods High in Uric Acid – a Surprising Myth.”
As uric acid results from purine breakdown, many have assumed that all purines are equal. Yet vegetable purines are no longer seen as serious as a source of gout. Unfortunately, other than statistical reviews, there is little hard analysis of the real effects of digesting particular foods.
The only way to test this is to take a reading just before, then 2 hours after, a meal. To find a true correlation, the “meal” would need to be one single food item, and it would need to be repeatable. Perhaps it is no wonder that studies like these never get done. I might try it myself – a bowl of lentils for lunch everyday could be just what I need
Continuation of my novel
Busy with project work so have not had much time to drive myself crazy. The toe keeps reminding that something is not normal down there. Got a list of Rheumatolagist in my area so will get an appointment next week. My Arctic machine should arrive by then as well so can play with some real numbers.
There is still 5-10% sweeling on my toe. Walking does not hurt much but I feel stuffed down there. Pressing at the spot still hurts even after 3+ weeks. Still hoping that it turns out not to be Gout after I see the Rheumatologist.
Anyway on average what kind of uric acid levels do Gout sufferers normally have without any medication? I read that some have as high as 12+. What is the upper limit of the measurment scale for humans?
Ok got an appointment and am seeing the Rheumatologist tomorrow. I hope he does the joint fluid test
GoutPal said:
I'd love to know his opinion on your risk for gout based on your recent uric acid test results.
Me too
You will be the first to know GoutPal. Today I got some other blood test results. I will take them with me to the Rheumatologist tomorrow. Do these numbers say anything to you?Vit B12 171 pmol/l (normal level 150-700)
Folic Acid 41 nmol/l (normal level 7-40)
Iron 180 ug/l (normal level 20-300)
Iron is not on the high side so that must be good from Gout pov. Folic acid is high though.
Ok went to see Rheumatologist. Had to strip down again. He checked everything from my hip bone position to my feet. He was taking lot of detailed notes. I had also taken photos of my toe at the worst pain stage plus all the blood test readings and X-rays. He said yes the uric acid levels are higher than normal but he is confident that it is not acute gout. I asked him if I could have my toe joint liquid analyzed for peace of mind and he repeated what my GP had said. He said I have no to low level swelling so it is not easy to take the liquid out and it would be pointless. He said my feet are wide near the front and that sometimes causes pain like I am experiencing combined with over excertion of the joint. He said the only thing he can offer me is to come back in 3 months to take another look at my blood uric acid levels ( I doubt that it would change much, in 2007 it was above 400 and now it's above 400 as well).
He said my diet also makes me a low risk canidate.
So there you are. I honestly don't know what to make of it all.
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