Sunday, April 15, 2018

Gout! My Journey

Gout

I have gout. Sometimes gout has me. Even taking medication does not stop gout attacks and I have flares periodically. So what is gout? Why am I spending a whole post on gout?

What is it?
According to Google, gout is...
1. a disease in which defective metabolism of uric acid causes arthritis, especially in the smaller bones of the feet, deposition of chalkstones, and episodes of acute pain.
2. <literary> a drop or spot, especially of blood, smoke, or flame.
"gouts of flame and phlegm"


As per the Mayo Clinic...
"Gout is a common and complex form of arthritis that can affect anyone. It is characterized by sudden, severe attacks of pain, swelling, redness and tenderness in the joints, often the joint at the base of the big toe.
A gout attack can occur suddenly, often with the sensation that your big toe is on fire. The affected joint is hot, swollen and so tender that even the weight of the sheet seems intolerable. Symptoms may come and go (referred to as gout flares)."
Signs & Symptoms (Mayo Clinic) ...
... almost always occur suddenly, and often at night. They include:
  • Intense joint pain. 
    • Gout usually affects the large joint of your big toe, but it can occur in any joint. 
      • Other commonly affected joints include the ankles, knees, elbows, wrists and fingers. (For me, I also get inflammation and tenderness in my Sacroiliac joints, too.)
    • The pain is likely to be most severe within the first four to 12 hours after it begins, but can linger for extended periods of time.
  • Lingering discomfort. 
    • After the most severe pain subsides, some joint discomfort may last from a few days to a few weeks. 
    • Later attacks are likely to last longer and affect more joints.
  • Inflammation and redness. 
    • The affected joint or joints become swollen, tender, warm and red.
  • Limited range of motion. 
    • As gout progresses, you may not be able to move your joints normally due to destructive changes to the joints
So why a whole post on gout? 
Well, for one thing, I found information connecting gout to brain fog but I could not find any information on the major health centers websites regarding the body aches. I suffer from gout, and have suffered since longer than I realized. I was finally diagnosed when I was in my early 30's, I am now 40. The diagnosis came from years of unknown foot and ankle pain that progressively got worse as I got older; it started in my early 20's. I would usually wake up and have foot and ankle pain that I could not explain nor account for, but it was excruciating. Some attacks would have me asking, "did I sprain my ankle in my sleep?" "Did I fracture my ankle yesterday and not notice?" "Did I drink last night?" I could never answer any of those questions, and the pain would usually subside within a day or so. As I approached my 30's, I began to notice more symptoms evolving around the gout flares. I would become inexplicably irritable days before the foot pain. I would wake up in a brain fog as well, and it would linger from before the gout flare until days after the flare subsided. My sleep would become poor as I would wake often. Finally, I would develop body aches even without the foot and ankle pain. These body aches would include achy joints, decreases strength, fluid retention, muscle soreness and intense muscle spasms. I am forced to become sedentary during these bouts as exercise made everything worse. 
I have not found any information from reputable sources on the body aches being connected with gout but I found that depression disorders are very much correlated. So while the body aches seem unexplained, the brain fog and irritability most certainly are:  
  • In a nationwide cohort study, involving 34,050 participants, there is some kind of correlation between gout and depression (depressive disorders). Basically, anyone who has reoccurring or chronic pain is more likely to suffer from depression, especially as they get older. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5291635/
I will tell you my hypothesis on the body aches, in addition to the depression. My best educated guess is the body ache's (achy joints, fluid retention, decreased strength, muscle soreness, and intense muscle spasms) are from some sort of toxicity. I'm not a chemist, but based on how I feel, I would say that my body feels "toxic." Seeing as how gout is a problem with uric acid metabolism (breakdown and excretion), it makes sense that the elevated uric acid in the blood stream and tissues creates a toxicity situation. Either the uric acid itself is creating the toxicity, or the elevated uric acid in the body is also interfering with other metabolic processes creating a cascade of multiple minor toxic events. All together, the feeling is a body that does not work properly. 
This hypothesis is only an educated guess by a guy who is not a chemist, physiologist, nor nephrologist. I am only guessing as to what is happening in my body.

"He who is proud of his knowledge, has gout in the wrong end."
Thomas Adams
"That city is in a bad case whose physician hath the gout." ~Hebrew proverb
"Screw up the vise as tightly as possible — you have rheumatism; give it another turn, and that is gout."~Popular jest, c.1823
"Having a gout flareup in your toe is like having your toe catch on fire, and then putting out the fire by slamming it with a hammer." ~Anonymous urgent care clinic patient, 2011
"If you drink wine, you have the gout; if you don't drink wine, the gout will have you." ~German proverb
"Love, fire, a cough, the itch, and gout are not to be concealed." ~German proverb
"Gout is like is like waking up with a hangover, except instead of a headache there is blinding foot pain that will soon awaken other rheumatism." ~DocBDC

To any and all of those reading afflicted with gout, you are not alone.
Thank you for reading, as always,

DocBDC

<At the time of this post I am in the midst of a 2 week attack.>
<Week 1 was irritability and brain fog (depression)>
<Week 2 is the above plus crippling foot pain>
<My insurance company has denied coverage for my gout medicine so I'm relying on samples from my nephrologist. When those run out...>