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Leaking Gout
My husband is only in his 30s and has had chronic gout for about 6 or 7 years. His attacks have increased. He gets them almost bi-weekly. We have changed his diet to try to reduce his uric acid level. He has been taking allopurinol and colchicine. His regular doctor currently prescribed prednisone.
After all this time we have finally gotten the regular doctor to refer him to a rheumatologist. However, his appointment is not until December.
During the course of about a year or two he developed a large nodule on his big toe. About seven months ago, he poked a hole in it with a needle. Why he did this, I have no clue. This sore has never healed. From the hole came a whitish, thick fluid. His doctor told him to “not do that again.” The hole formed a scab over it. However, two days ago the scab burst open. The nodule or tophi (I saw it called that on your site) has begun to bleed and leak the white fluid again. It is seriously swollen and causing my husband much pain.
Yesterday, he soaked it most of the day in either peroxide or alcohol. Should my husband see a doctor about this?
We feel like the regular doctor is no help. He has visited the emergency room so many times with flare-ups that they know him by name. However, the tophi has never been bleeding and oozing like it is now. We are unsure about what course of action we need to take, but do not know who to seek medical help from. No one around here takes his gout seriously enough to help.
Anything would be helpful.
Your husband should seek emergency treatment for the tophi – there is a serious risk of infection.
I hope the rheumatologist can finally get your husband on treatment that works. Perhaps you could write to him to ask if there is anything that can be done before December.
Have him use an over the counter triple antibiotic (usually bacitracin, neomycin, and another) and apply it daily as long as the wound is open. Then dress it with sterile gauze. But don’t worry about the oozing. As long as there is white material coming out, the tophus is discarding urate.
I am not sure of the recommended medical treatment, but what I would do is hot water soaks (of course not scalding) with some basic material added, like several Tbsp baking soda. Maybe there is some question about whether your husband should have pierced the tophus, but now that it is a done deal, might as well make the best of it.
There SHOULDN’T be too much blood, I hope. If the exudate is almost all white, I would encourage drainage with some gentle massage while the foot is nice and warm. When he’s gotten out all that’s coming, use a little antibiotic and gauze it.
Repeat the next day.
With urate, my mottos is “better out than in.” Remember, once it heals over the urate purge ends.
(I punctured one on my thumb and squished and squeezed for a week, but I’m rid of that tophus.)
Star said: Star said:
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Anything would be helpful.
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Print Manuka Honey in the SEARCH field of the upper right-hand corner and you'll get 4 posts. Read them all, but particularly the last two which deal with Manuka honey. It was that particular honey which healed my open tophi wounds. You'll see a photo of them. I'll be glad to direct you to my supplier of the honey.
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This is a photo of tophi on my toe.
I have the tophi scraped off every 2 weeks by a podiatrist.It is now 9 months since this started and my uric acid level has been normal since november at least.
Do you think I will win a foot beauty contest ? LOL
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OUCH,
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Jerry, If I had that toe at the end of my foot I wouldn't be able to resist taking a dental pick GENTLY to that whitee area on the top inside of the toe. Perhaps I could ignor it for an hour or so but then I would HAVE to dive in.
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How long did it take to get that big?
zip2play said:
OUCH,
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Jerry, If I had that toe at the end of my foot I wouldn't be able to resist taking a dental pick GENTLY to that whitee area on the top inside of the toe. Perhaps I could ignor it for an hour or so but then I would HAVE to dive in.
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How long did it take to get that big?
It started as a white lump which burst in April 2010.
As I said the podiatrist scrapes ir fortnightly.
That photo was taken 3 days after it was cleaned of all tophi.
from Gerry: That photo was taken 3 days after it was cleaned of all tophi.
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Your podiatrist missed a bunch becasue I can clearly see exposed “chalk” which is FAR from where your toe joint should be. Is it possible he wants you coming back every fortnight FOREVER?
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What drugs are you taking and how long have you been on it/them?
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(I apologize for my memory and ther's no way that I can see?to call up your old posts in one place.)
zip2play said:
from Gerry: That photo was taken 3 days after it was cleaned of all tophi.
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Your podiatrist missed a bunch becasue I can clearly see exposed “chalk” which is FAR from where your toe joint should be. Is it possible he wants you coming back every fortnight FOREVER?
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What drugs are you taking and how long have you been on it/them?
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(I apologize for my memory and ther's no way that I can see?to call up your old posts in one place.)
My uric acil level is 0.32 mmol/L, I am on Probenecid since November and the tophi only takes a day to form after the toe is cleaned but it is getting less painful and the amount of urate coming out is slowly decreasing.
The toe is clean after being scraped.? ?
Gerry,
Since you have chronic tophaceous gout perhaps you might consider getting your urate level lower. I translate your molar reading to about 5.3 mg./dL.
Levels down to 3.0 are sometimes used to clear tophi. It is acheivable using TWO urate controlling drugs, a xanthine oxidase blocker and a uricosuric.
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Are your doctor's excursions with a pickaxe very painful? Does he anesthetize the toe?
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Keith,
Thanks for the SEARCH tip and for the?kind personal reference.
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