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Hello all,
I'm happy to share about my first bout with gout, but that discussion will be better informed after I do a follow-up with the doc for more UA testing. As of right now, the debilitating pain (I'd poetically try to call it brilliant, perfect or exquisite or something–truly stunning) has subsided to a dull ache, and I'll go for more tests a week or two after that subsides as well. This is to say that my UA tests were “normal,” according to the doc, and I obviously didn't know at that point to ask for the number.
The main point of this post, though, is to offer a huge thank-you to the Gout Pal regulars, whose informed opinions and perspectives have been the most valuable thing I've found on the disease. You should all collaborate on a book. I am stunned by the amount of contradictory, misleading and ill-informed information available on the world wide web–and for a disease that's been established since history was first recorded. My hat is off to you all. In addition to being proactive about your gout, you are offering an enormously beneficial public service. Thank-you!
So, for those who care to read a bit more knowing I don't have UA numbers yet, here's my back story:I'm 38, 5'10″, a pretty fit 180 pounds, though when my first symptoms arose last September I was closer to 205 pounds (certainly overweight). I have always had a relatively good diet. Practically no sweets. Not too much meat. My weaknesses are lack of fruits and vegitables and too much processed food (because I'm lazy in the kitchen) and beer, which I have enjoyed both in moderation and to excess on occasion since I was old enough to try it–probably the source of my extra weight, too. I live a mountain lifestyle and am extremely active: skiing, rock climbing, peak bagging, whitewater kayaking, mountain biking, etc. etc. etc. After asking around, I had one grandfather who was diagnosed with gout at some point. I don't think it was chronic, either that or he was on meds that I didn't know about.
Last fall, in September 2010, realizing I'd let my weight go for too long, I enlisted at the gym to restart the old habit of pumping iron and doing spin classes and such. Along with the membership, they managed to sell me a heavily vitamin fortified whey protien supplement. As this was the first I'd lifted weights in a few years, I began very gingerly working on very light weights to tighten up the bolts before trying to move more around and make faster gains. One of the exercises I did was lateral jumps over a step. About three weeks into this regimen, I noticed pain in my right toe, which I attributed to the jumps and the fact that my tendons hadn't absorbed such pressure in a while. I stopped the jumps and put custom insoles in my shoes. The dull ache remained, but lessened, and it was easy enough to ignore. I took the whey supplement for about 45 days, then discontinued, but continued to persue a protein-heavy diet to assist with strength building. In February, I returned to the whey supplement for about another 45 days. The toe ache ebbed and flowed thoughout this time, but I have no idea if or to what extent it coincided with the second round of supplementation.
Fast forward to this past spring: I'd lost 10-15 pounds, had some trouble putting the toe in and out of ski boots during winter, but because it was such a low-grade ache it was still easily ignorable. One one occasion a friend asked if I'd go rock climbing, and I declined because I knew my toe was too sore to stick in tiny rubber-soled slipper and then attempt putting all my weight on it alone.
This summer, I have continued to be very active, mountain biking 4-5 days a week, whitewater kayaking 2-3 days a week, hitting the gym at least once a week. Even hiked and skied Mt. St. Helens July 3.
And the toe pain was practically non-existant. Then, on July 15, I got sick, a nasty cold/flu that kept me in bed for the better part of 10 days, and there's little doubt that I overdosed on vitamins during that week–though ate absolutely no meat and hadn't had alcohol in weeks. On day number six of the illness, I woke at 5 a.m. with a super sore toe. I did what I'd learned to do: I ignored it. I went to bed again the next night and woke again too early, this time closer to 4 a.m. That toe was a throbbing mess. Any description I attempt will fail at accurately capturing the pain, but if you're reading this stuff you probably already know that it's difficult to conjur an appropriate list of expletives.Anyway, my story from here is like others who have posted. Went to the doc for a broken toe, was visually diagnosed with gout, got a prescription for indomethacin (which I will not use again because it makes me feel high and sick at the same time), uric acid and white cell blood tests came back “normal,” gout remained for what seems like longer than average: 8-10 days, I drank cherry juice, ate a vegetarian diet, didn't drink alcohol, peed five times a night, and so-on. Now I'm waiting for it to go completely away before I return to the doc for another uric acid test that I can hopefully compare with the first in numerical terms.
I offer all this detail, though, because I'm curious about the causes of gout. It seems obvious, I guess, that I may have a genetic predisposition and may develop chronic gout. If so, I'll move forward accordingly, and I appreciate this forum for knowing what that road might look like. However, the incidence of my sore toe last fall was in direct correlation to the addition of a whey protien dietary supplement, and my summer flare-up was in direct correlation to 1) being sick and 2) having likely toxic levels of vitamines (including niacin) in my system. I have other risk factors like beer, especially the yummy and purine-heavy IPAs, and a high stress load at work. But for the most part I am risk free and lead a pretty clean lifestyle.
I read an old thread on it, but does anyone have any further thoughts on protein supplements?
I'll update here when my next UA tests are done, probably mid to late August.
Cheers, and thanks again!
Hello! I'm back to report my lab results and the anecdotal story of how long my gout took to go away.
First, the labs:
My uric acid levels on July 22, two days after my acute gout flare, were 6.5 mg/dl.
My uric acid levels on Sept. 1, 42 days after my acute flare and about seven days after the dull ache finally mostly subsided, were 6.6 mg/dl. (It's worth noting that I've still got swelling in the joint, though it's operable again.)
Goign back, I realize I had mild gout in the big toe joint of my right foot for about eight months prior to my acute flare-up. It was a mild ache I attributed to a tendon strain or the like. My acute flare arrived on July 20. Very painful that day, but in the early morning hours of July 21 it became rather debilitating. I was prescribed indomethacin (no good for me), and I took it for about seven days before switching to heavy doses of ibuprofen. The acute flare lasted for 14 days or more, and the dull ache, swelling and limping lasted a full month and a half, probably 30-40 days. In fact, there's still some minor swelling, and I only managed to put a shoe on my foot for the first time about a week ago.
Anyway, my levels aren't super high. The doc this morning said he'd not worry too much about it until/unless I get another acute flare, and then consider meds.
Any thoughts on this? From what I've read, the length of time it took for this case to go away indicates a rather severe flare-up, but my UA levels are not too far over 6 mg/dl. It's worth saying, as well, that my diet was initially completely transformed, and I rapidly lost about 8 pounds. As the pain has subsided, I've reverted to some poor eating habits, but for the most part I've been eating and drinking very healthy for the past month and a half, with an actual 0.10 increase in my UA level.
Something to keep in mind – during (and immediately after) an acute attack, your uric acid level will drop.? I'm not sure I understand the reasoning, but it's entirely possible that your level of 6.6 mg/dL will continue to climb over the next few months, until it gets to a point that triggers another attack.
If the doc isn't prepared to prescribe meds at this point, I'd ask for a follow-up blood-test in 3 months to see where your SUA level is at.
The generally accepted minimum for uric acid is 6mg/dL. The more conservative recommendation, and the one I regard as most acceptable is 5mg/dL.
5 gives a greater margin for safety, and I believe this is important, as levels can fluctuate, and the risk of going over 6 is uric acid deposits that will destroy bone, cartilage and tendons.
Where would you rather be on your walk to gout freedom? In the middle of the highway or safely on the sidewalk?
It is not your doctors choice. Insist on treatment.
It’s been about nine months now since my first flare-up, and I’m happy to report that I’ve not had another acute flare–yet. Only some big toe aches that I’ve knocked back with pain killers. The purpose of this note is to raise a new consideration. Namely, anxiety.
After years and years of suffering from it, I’ve only just managed to put the anxiety label on myself. I’ve been diagnosed with Post Traumatic Stress Disorder from a long ago accident. But certain things triggered me, and I realize with some hindsight that I’ve probably struggled with anxiety for most of my life.
So, I’ve started a low-grade anti-anxiety drug called hydroxyzine and have started Eye Movement Desensitization and Reprocessing therapy. It’s too soon to tell if this will last, but all signs of gout have vanished (not to mention an improved sex drive, improved concentration, and I’ve stopped grinding my teeth).
I searched the forum for info on this and came up with some a few loose references. Anyone have any feedback about potential gout-anxiety links?
Thanks!
Welcome back rockymountainhigh.
I’m pleased you have not had a gout flare, but I hope you are keeping up with uric acid tests every three months or so. I guess you could relax this to once or twice a year, as you are not getting attacks. As Ravenwood pointed out, the test has most value when you have not had a recent flare. Knowing the number gives you a chance of assessing if you are managing gout, or just getting lucky. Uric acid crystals can grow slowly, especially in the 6.5 to 7 range. This means you can be suffering damage without realizing – until the pain hits.
Also welcome to the PTSD club. I am not convinced that there are any specific gout-anxiety links. Generally, I can see that the trauma of gout pain, and worries about medications are almost certain to cause stress, but individuals will deal with this differently, as they will with all anxiety and trauma. I have a half-baked theory that many reported side-effects are caused by anxiety.
The most important consideration for me, is dealing with PTSD, which I know is not medically linked to gout, though there must be personal connections, just as there are personal connections between all aspects of our lives. In my understanding, my problems are relatively minor, though I think there is no real scale for “cannot cope” – it’s on or off.
How do you feel about joining me on a new project to investigate the best layman’s approach to PTSD? I beat gout by creating a website to encourage myself to learn about it. I’m sure we can help ourselves and others by doing a similar thing with specific PTSD or more general stress. Any thoughts?
Coincidentally, today is the anniversary of the source of my PTSD. Time to thank my loyal gouty friends for the support and encouragement I have received. I almost feel I should be celebrating my first birthday today, though I didn’t revive until the 11th, so maybe it should be tomorrow. For newcomers confused by this, see https://gout-pal.com/goutpal-on-the-mend/2011/04/
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