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I had my first gout attack at the age of 37, which was 6 years ago now. It was a classic textbook attack, the base of my right big toe, felt like wlaking on glass, swollen and hot — all the classic symptoms, and it lasted in its acute stage about 4 days. By the 5th day i could walk again but it was several weeks before I was free from moderate, nagging pain in that joint.
In the 6 years since that time, I have not had another attack that severe, but what I have experienced is 6 years of mild to moderate pain that seems to migrate from one joint to another. At first, it was only in the right foot, no more severe attacks, but occasional stiffness or tenderness that became more frequent as time went by. Then about 3 years ago, I started feeling the same occasional stiffness or soreness in other joints, sometimes at the base of one of my thumbs, sometimes in a shoulder, or a wrist. Sometimes it woud be a long-lasting dull ache, other times it would be a tenderness that produced only a momentary sharp pain in the joint if it bent in a certain direction or had a certain amount of pressure put on it.
Now, as of Jan 5, 2010, I am experiencing the first actual gout attack since that one I had 6 years ago, and it not as severe. I woke up with pain yesterday, it seemed to be gone by the evening, but was back again this morning, only worse and now with some moderate swelling. This time it is in the other foot, and instead of at the base of the toe, it is actually further out in the final joint of the toe – but it has not been severe enough to keep me from walking, and 800mg of ibuprofen has taken alot of the pain and swelling away.
I have read alot of the posts here on food and drink causing gout, and in my case anyway, the pain seems to be closely related to my eating and drinking habits. Throughout my 20's and 30's I was a moderate drinker — I'd imbibe on 1 or perhaps 2 evenings a week, averaging about 5-7 drinks per occasion. I never was much of a liquor or whisky drinker, but was very fond of what we call in the US “Craft Beers”. Also I enjoyed wine on occasion.
Since then I have noticed that the stiffness and tenderness usually follows an evening of having a few drinks, and goes away after a few days of abstinence. I've also noticed how my diet makes a big difference in it too — lots of meat, or especially fish, and I'll have some pain or stiffness, but not if I focus more on fruits and veggies.
So, for most of the time, I keep alcohol down to once or twice a month (and only in the form of red wine), opt for 5 or 6 servings fruit a day and meat only once a day (and at least one day a week meat free). It has worked well for me, preventing serious attcaks, and keeping the joint stiffness to a minimum.
The fact that I am having an attack now seems to confirm my suspicions because I spent the holiday period eating a lot of “forbidden” foods — smoked salmon, ham, chocolate, sugary sweets, cheeseballs, and having much more wine and beer than usual. And bingo, I woke up yesterday with a moderate attack. I don't think any one of these treats would have caused it individually, but the accumulated effects of 2 weeks of bad food choices is definitely the culprit in this case. (Also, cold winter weather the lack of exercise the weather enforces on me contribute as well).
My personal experience is that lifestyle issues (food, drink and exercise) seem to be the main factor in my own gout history.
I can also associate many of the points that you mention, but I remain convinced that they are secondary to managing uric acid.
Alcohol, for example makes me much more susceptible to, and aware of, inflammation. We can often cope with high uric acid, and not notice the slow build-up of uric acid. But add alcohol and other inflammatory factors into the mix, and our bodies soon switch from discomfort to full on gout flare.
There are many complicating factors here, but the basic problem is that by associating lifestyle issues with gout pain we lose a significant element of control. We need to associate these things with uric acid levels, as this is ultimately the thing that matters.
As a practical explanation, the factors you list in your next to last paragraph may well have contributed to an increase in uric acid leading to crystals that caused a gout attack. Let us assume for the moment they are the only factors. If you knock them all out, you may still get gout attacks for a few weeks as old uric acid crystals dissolve. The missing measure is uric acid. This is of supreme importance in the real world because there are many other factors besides the ones you list.
To get any meaningful control over gout, you must control uric acid first. Whether you excercise control through drugs, diet or a combination, pain is secondary to uric acid control.
WYVPAT, your experience echoes my thinking on gout.
Careful watching of of diet,exercise and alcohol intake coupled with swift responses can pay dividends.
There many ways to micromanage gout without necessarily resorting to meds for long term care.
However, this does include some risk that you will slowly lay down deposits of urate whilst floating around the 6+ marker of SUA. This may be a preferred choice to yet more meds, long term.
Blood tests would be needed to monitor how successful your efforts were, at least annually.
With increasing age, weight, BP etc. the balance will get harder to maintain-
I still hold back the meds till they absolutely must be used, but I'm mindful of the risks of high SUA, irrespective of attack frequency.
Gout gets worse with age, and the accumulated effect of more and more urate. Rare attacks become occasional attacks become frequent attacks and if left untreated, a single permanent attack. Thus in the early stages we may be lulled into the useefulness of finding triggers, eating low on thhe purine scale, etc. but once you have laid down crystals you will never get the point where your body can handle a serum supersaturated with uric acid. Thus, once you have gout you can never return to non-goutedness.
Yes it is human nature to avoid a lifetime of drugs…denial is very much a part of humanity but gout has a way of making the eventual path CRYSTAL
clear.WVPAT,
I strongly recoommend you check your uric acid levels if you haven't already. Perhaps if the level is low enough to warrant conservative control then you could kleep on keeping on. But if you have uric acid levels of 8, 9, or 10, then you need medication to prevent a downward spiral with gout.
In the 6 years since that time, I have not had another attack that severe.
What the usual routine is that, without drugs, you will AGAIN suffer an attack that is even worse than the first…and that will put you on the right path. An attack of gout can be truly merciless…think amputation without anaesthetic. You can wait for it or you can avoid it…most of us wait.
My experience is that I've dropped back to one attack a year for the last two years [both max on the scale for pain ] after an average of 3 or 4.
This due to meds adjustment and reduction of stress/ exhaustion levels I reckon. [Not the threat of AlloP lurking in the cupboard!]
I agree that Wvpat needs to get a blood test of SUA to support coping with gout , with or without meds.
I think, as well, as a useful marker will indicate likelihood of ongoing success of preferred regime.
ie: Would need to be not excessively high- as Zip suggests.
GoutPal said:
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To get any meaningful control over gout, you MUST control uric acid first. Whether you exercise control through drugs, diet or a combination, pain is secondary to uric acid control.
After more than 25 years of living according to zip2play's recipe: “…once you have laid down crystals you will never get the point where your body can handle a serum supersaturated with uric acid. Thus, once you have gout you can never return to non-goutedness
. Yes it is human nature to avoid a lifetime of drugs…denial is very much a part of humanity but gout has a way of making the eventual path CRYSTAL clear.” … I can assure you, neither GP nor zip2play could be MORE RIGHT.Hans
hansinnm said:
zip2play's recipe…
Thus, once you have gout you can never return to non-goutedness
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Actually 100% plus true…Even a re-birth or reincarnation would not help….the genes will get passed on to new soul that would trigger gout…So, it is birth after birth…once you have it…it is for ever…..till eternity I guess……
The problem with gout is the Medical community doesn't see it as important(at least in the USA).If gout reserch or treatment brought the big money like cancer or carido. Md's would jump all over it. If the President or the Surgen general had a gout attact you would see alot of reserch, till something like that happens all we have are sites like this (A great site) to find help and friends who understand
The problem with gout not being topline for research effort is the genetic wild card.
Dietary control would be a major input if those vulnerrable to high SUA induced gout could be identified
Checking large sample SUA levels and advising against an unknown level of threat in general would not work well , anymore than obesity advice does.
Unless the genes predisposing to gout can be identified then the right patients won't be identified soon enough -and all that expensive & lengthy research would have to be driven by Gov't- as the meds usage for gout would shrink dramatically as new cases fell amd Pharma would be cutiing its' own throat!
If Obama had gout- it would be hushed up, or I am I my usual cynical self?
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