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  • #1

    Question about gout

    To anyone with medical knowledge:

    I began allopurinol therapy in May 2008 to treat severe interval gout that had been in and out of flare-ups for four years, so much so that the knuckle of my left big toe had a pronounced bump on it for a few months.

    It hurt like hell, like I had sand in all my joints. It took 6-8 weeks for the pain to go away. No gout since then, except one time when I got really dehydrated from the stomach flu.

    Since August 2008, I have had a "heel spur" type growth inside of my Achilles tendon; every step I've taken since then causes moderate pain; when I wake, I have to spend five minutes stretching the tendon; I wear an AirCam Walker every day, and I try and sleep with a dorsiflexion boot unit. While I know that heel spurs are on the bottom of feet, this is what the podiatrist called it. An orthopedist just opened up shop in our town, so I'm going to call and get an appointment today, but, I'm wondering, could the source of the pain be a side effect of allopurinol therapy? I don't know where to look to find uncommon side effects to that drug.

    Could the "spur" be a uric acid tophi attached to the Achilles insertion?

    I'm almost curious enough to stop the allopurinol to see if the tendon pain goes away, but gout hurts worse than anything I've ever felt, or could likely imagine, so that's a big risk on a lay hunch.

    Anyway, thanks for any thoughts on the subject.
    "Wuap's "problem" is that he is smart & principled & committed to a moral course of action. His actions are supposed to reflect his ethical code.
    The rest of us rarely bother to think about our actions." --Solon
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  • #2
    Uric acid crystals aren't usually radio-opaque (visible on an xray). Heel spurs usually are calcifications in the plantar fascia insertion on the calcaneus. Gout usually affects joints (i.e. the big toe - Sgt. Hulka) - the bottom of the calcaneus is relatively far away from any joint and would be an unlikely location for uric acid deposits.
    "You interns are like swallows. You shit all over my patients for six weeks and then fly off."

    "Don't be sorry, it's not your fault. It's my fault for overestimating your competence."

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    • #3
      Just got back from the doctor regarding some foot pain that I thought was tendonitis as I have had flare up in the past from overuse (i.e. big fat guy on feet not intended to carry that much weight) and he thinks it may be gout.

      They took some blood and are testing for uric acid. I've done some googling on it and I see where he is coming from. It's near but not right on the knuckle of my big toe on my right foot. More to the outside and a little further back. But it is swollen and red.

      What made me think tendonitis is I got on the treadmill a week or so ago just walking for about 40 minutes and it started hurting after that.

      I guess we'll see after the blood test comes back. Part of me wonder though that if a PCP sees a fat guy with foot pain there gout is just assumed.

      In the meantime it seems the treatment is fine / similar to what tendonitis would be. He prescribed Indomethacin (50mg 3x daily), which he says is an anti-inflammatory similar to ibuprofen but better for gout. Also said to keep it elevated and ice it.

      Any input would be appreciated.
      "It's true that everything happens for a reason. Just remember that sometimes that reason is that you did something really, really, stupid."

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      • #4
        1. Indomethacin will burn a hole in your stomach. Be careful with it.

        2. My first diagnosed gout attack came after I walked about 2 miles one day.

        3. Avoid all shellfish, cauliflower, yeasty breads, organ meats, and anything rich in purines. Uric acid is a product of purine synthesis, and eating these things will make it worse.

        4. While it hurts, double the volume of liquids you consume.

        5. Some people swear by black cherries, but I've never known them to help remarkably.

        There are three medicines that have helped me:

        1. Colchecine for acute flareups.
        2. Vicodin for acute flareups for pain.
        3. Allopurinol for maintainance. I'm back on it now, and my acid levels are normal. $10 for 3 months at Wal-Mart.

        If you're asking yourself if you've had an acute attack yet or not, you haven't. You'll know when you do. Of all the traumas and surgeries and illnesses I've had, NOTHING, and I mean NOTHING, holds a candle to the pain of gout. I can't even stand to have a fan blowing on the joint. I once considered just wetting myself rather than hobbling to the bathroom.

        I hope yours is mild and controllable.
        "Wuap's "problem" is that he is smart & principled & committed to a moral course of action. His actions are supposed to reflect his ethical code.
        The rest of us rarely bother to think about our actions." --Solon

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        • #5
          I echo Wuaps words.

          Regarding location of the pain, that is precisely where mine hurt when I first got gout. The Dr.'s were puzzled because it wasn't in the joint of the big toe, but testing confirmed it was gout.

          I am one of the people who thinks black cherry juice and celery have helped during an attack. Maybe it's placebo, but that's fine with me.

          Once you come to understand what it feels like, you'll realize that about a day or so before real pain begins, you will feel a tinge of pain. When you feel that, do three things: (1) take an anti inflammatory and continue to take it per instructions, (2) drink a shit ton of water, and (3) take 1500 mg of vitamin C, and take 500mg more every four hours or so. I don't know if the Vitamin C actually does anything, but since I started using this technique, I've been able to nip gout attacks in the bud.

          Best of luck.
          Jesus wants me for a sunbeam.

          "Cog dis is a bitch." -James Patterson

          Comment

          • #6
            What causes gout?

            Comment

            • #7
              Originally posted by Levin View Post
              What causes gout?
              I'm going with genetics. That's my story and I'm sticking to it. I am certain it has nothing to do with the fact that I share the same physical characteristics to many others I have spoken to that have it.
              "It's true that everything happens for a reason. Just remember that sometimes that reason is that you did something really, really, stupid."

              Comment

              • #8
                Originally posted by Levin View Post
                What causes gout?
                Smugness, pride, and brilliance. I'm amazed you don't have it.
                "Wuap's "problem" is that he is smart & principled & committed to a moral course of action. His actions are supposed to reflect his ethical code.
                The rest of us rarely bother to think about our actions." --Solon

                Comment

                • #9
                  Originally posted by Levin View Post
                  What causes gout?
                  "You interns are like swallows. You shit all over my patients for six weeks and then fly off."

                  "Don't be sorry, it's not your fault. It's my fault for overestimating your competence."

                  Comment

                  • #10
                    Originally posted by wuapinmon View Post
                    Smugness, pride, and brilliance. I'm amazed you don't have it.
                    Insane good looks and a supple figure.
                    Jesus wants me for a sunbeam.

                    "Cog dis is a bitch." -James Patterson

                    Comment

                    • #11
                      Originally posted by FMCoug View Post
                      I'm going with genetics. That's my story and I'm sticking to it. I am certain it has nothing to do with the fact that I share the same physical characteristics to many others I have spoken to that have it.
                      Is it related to "huskiness"? I never thought that since a guy I work with has it, and he is as thin as a rail.

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                      • #12
                        Originally posted by Clark Addison View Post
                        Is it related to "huskiness"? I never thought that since a guy I work with has it, and he is as thin as a rail.
                        It's definitely a factor, but not the only one.

                        It's a mixture of age, weight, eating/drinking habits (related to weight, obviously), and genetic disposition. Some folks are just going to get gout. Others get gout based on life decisions. I'm in the latter category, but am working on it.
                        Jesus wants me for a sunbeam.

                        "Cog dis is a bitch." -James Patterson

                        Comment

                        • #13
                          Originally posted by Levin View Post
                          What causes gout?
                          Overproduction or under excretion of urate by the kidneys and/or over consumption of purine rich foods cause hyperuracemia. When the monosodium urate (MSU) reaches a certain level, crystals form and...ouch. It is a bunch of chemistry. The idea, though, is that joints are cooler than the normal body temp, thus allowing the MSU to form crystals at lower concentrations than in other parts of the body.
                          "Don't expect I'll see you 'till after the race"

                          "So where does the power come from to see the race to its end...from within"

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                          • #14
                            Lab work is back. They said I have "mildly high levels of uric acid" which is consistent with gout. Perhaps the mild levels is why I am not experiencing the level of pain others have described?

                            In any case he wants me to start on allopurinol after this episode passes. Not sure why I have to wait.

                            Also, after a day on the Indomethacin I can't say it feels measurably better. How long should it take?

                            Humor aside, input from the docs would be great.
                            "It's true that everything happens for a reason. Just remember that sometimes that reason is that you did something really, really, stupid."

                            Comment

                            • #15
                              Until I was about 25 I was under the impression that Gout was one of those fake old-timey diseases that they thought were caused by sleeping in a breeze, eating foods in the wrong order, not having enough sex, having too much sex, thinking too hard, etc.

                              Others in this category include Dropsy, the Vapours, Pleurisy, Grippe, Croupe, etc.

                              Shingles was in the same group until a guy in my ward got it.

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