Rich Man’s Disease

Last Tuesday I awoke with a sore big toe on my right foot. It felt like I’d sprained it in my sleep. Weird. I hobbled to work and told the people around me that I had somehow injured myself without realizing it. I limped through the day and wondered how long it would take before the pain subsided.

That night was pretty bad. Even lying in bed, my toe hurt like a mo-fo. Wednesday I went to work but I was miserable. “I’m taking you to urgent care,” my boss told me. I was not going to argue. Whatever I’d done to myself, I’d done a thorough job of it.

The Gout

James Gillray, 1799

While I filled out the various forms and signed stuff, my boss and a coworker went to fetch food. I thought a Carne Asada Burrito and a Coke would be delicious and easy to handle in the waiting area. “Diet or regular?” Boss-lady asked, and I responded with my usual quip: “I prefer the known health consequences of sugar.”

They came back with the food, and I was just getting the last of the burrito down my gullet when my name was called. After a quick stop at the blood pressure machine (in the normal range, to my relief), I was parked in a room to wait for the doctor. While I waited I gently peeled off my sandal and sock (discomfort trumps fashion), and flipped through an issue of Entertainment Weekly looking for signs of intelligent life.

It was only a few minutes before the doctor came in and took a seat. “Hurt your foot?” he asked, glancing at the unhappy extremity.

“Yeah,” I said.

“You remember how you did it?”

Funny he should ask that. “No, in fact I don’t. I woke up in the morning and it hurt.”

He was nodding. “Gout,” he said.

“Gout!?” I knew pretty much nothing about the gout, except that it’s connected with gluttony.

He took hold of my foot and ran his fingers over the angry, swollen area. “Does it hurt down here?” he asked, prodding the tip of my big toe.

“Not really.”

“More up here?” He gently pressed at the heart of my discomfort.

“Yep, that’s the spot.”

He nodded again. “I’m pretty sure it’s gout,” he said. “We’ll do some tests to make sure it’s not something else. There’s also a test we can do to confirm it absolutely, but…” he hesitated. “We take a sample from inside the joint. It can be pretty painful.” He gently released my foot. “You have pepperoni, lately, or sausage? Liver? Have you started taking any new medications?”

The previous evening I’d feasted on spicy hot links. Man, are those things tasty. It turns out I was speaking with a fellow sufferer. “I found out after taking water pills,” he said.

So, gout: what happens is this. Protein is broken down and one of the byproducts is uric acid. The kidneys are responsible for collecting the stuff and shipping it out to the bladder. It’s what make your pee yellow. If, for some reason, your kidneys fall behind, the uric acid can form crystals, commonly at the top of the big toe. (See diagram above.) These crystals make a fine abrasive, but the pain and inflammation (a form of arthritis) comes from the immune system attacking the inorganic matter and failing epically. When the first white blood cells explode against the unfeeling enemy, word goes out through the body: Send more white blood cells. You can guess the rest.

Ironically, I was sitting there looking at a known health consequence of sugar. (Fructose, specifically.) Mainly I was looking at a consequence of having a big belly. Other bad things: alcohol (especially beer), the aforementioned giblets, possibly seafood, and on and on. I’ve been working on making some lifestyle changes, and now I have a condition that rewards slipping off the diet with a pretty nasty dose of pain. It’s possible that this disease will actually make me healthier.

My sweetie loves to feed me, and I love to eat her food. Her cooking is healthy, but it’s tasty and I’m always happy to pile my plate high. That’s going to be the most difficult adjustment, I think. There’s nothing like sitting back with a belly full of good chow, but I’m going to have to settle for “enough”, now, rather than “plenty”.