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”.

13 thoughts on “Rich Man’s Disease

  1. I have gout. I now many people who have it. I have tried the diets (early in my post-diagnosis period) and nothing helped (not even going on the wagon). It has to do with your metabolism. I have been taking allopurinol (cheap!) for well over a decade and it keeps it in check. Most of my friends who have it do the same and don’t have to suffer through the silly anti-gout diets which don’t work in the majority of cases anyway.

    Take the one pill a day, drink beer, eat seafood and whatever else. If you don’t take the pills on night, maybe not far in the future, you’ll find yourself crawling to the bathroom to take a leak and screaming in pain the whole time. The diet changes really don’t work, but I haven’t had an attack in over ten years.

    • While the diet may not completely solve this problem, it will make my shirts fit better and take pressure off my tired old knees, so overall the diet is a win even if I have to use other medication as well.

      I’m not talking abstinence here, just getting the ol’ belly under control. Lots of things will be better if I do.

      • Yeah, that’s true, but it probably won’t cure your gout. I kept getting brutal attacks in my 30’s when I had my weight under control (about 190 – 200, which is about as good as I can get). I finally gave in started taking the pills when I was about 35 or so.

  2. Gout sucks. See the comment I left at your blog. Shorter comment: diets don’t work. Take allopurinol and live life w/o fear of attacks. They get worse as time goes on and can become crippling. Gout is NOT fun and diets do not work. Nobody I know who has it has had any success with them. And they are mind roastingly boring.

  3. Does your sweetie know you’re a rich man?
    It’s always an uncomfortable thing when I shill, but Morningstar grilled vegan burgers are pretty dang delicious, and super convenient. Keep em in the freezer, microwave for 2 minutes, and voila’ tasty treat.
    Splinter in big toe
    crystalized rich man acid
    need to work it gout

    • She does the finances, so she knows better than I do whether I’m rich or not. :)

      Veggie burgers are already a regular part of our diet, due largely to the convenience factor you mention above. Until my belly stops growing, I need to have one veggie burger rather than two.

      Thanks for the haiku! For security I didn’t install phpMyAdmin on the new server, which is a program that simplifies routine database admin. Things like adding a poem to the rotation. Doing it from the command line is no biggie, but methinks it’s time to learn to script MySQL. How hard can it be?

      • Yes, Morningstar veggie burgers are a staple here, purchased in large bags from Costco and always in the freezer, one of the “my brain has dumbth and can’t think the foods” go-to meals I make sure is there when needed. And they are delicious :)

  4. I have pseudogout, which has all the same symptoms, but involves a different chemical crystal (calcium pyrophosphate, IIRC). I was in so much pain from PG prior to a significant knee surgery (full slice of the IT band from the outside, on top of artho) that I was more comfortable post-op, as they were able to drain the crystal-containing synovial fluid (and scrape a bit more crystal off the surfaces) while they were in there. For me, PG was worse than a pair of knee surgeries, one which required 6-months of inactivity. I mention this because (beyond just whingeing):
    – If you have PG, then pills, diet, etc. won’t help, so you can save yourself the effort
    – They can aspirate the joint and make the diagnosis quickly with 100% accuracy (if you go in while swollen)
    – In my experience, it’s the combo of PG and joint trauma that creates flare-ups … my knee has to already be irritated by something else to balloon up from PG, and the only other place I’ve had this issue is the outside of my right foot, which is too wide for most shoes. I suspect you get crystals growing on surfaces, which act like a seed, and it’s when they get knocked loose and start getting into new crevices that you feel pain (i.e. it’s not *just* an autoimmune disease). It could be that avoiding stress on the big toe could duck the incidents .. you might even have a medical excuse to wear sandals to work.

    • I have another friend with pseudogout, and it’s pretty clear that what I have is, indeed, the gout. Which in the long run is probably better for me. When I get back home and I go on my new insurance I’ll find myself a regular doctor and we’ll get to the bottom of this.

      And, as I told my cousin, there’s no bad reason to adopt healthy habits. Which I’m gonna do right after this beer.

      Excuse for sandals to work? Happily not necessary. The only dress code issue I face is which aloha shirt to wear for my new badge photo.

      Or a czech hokej shirt – I hadn’t considered that.

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