Gout
Gout
Does your toe hurt like the dickens today? If the answer is yes, the cause may date all the way back to your adolescence. Somewhere in your teen years, the bad stuff called uric acid started to circulate in your blood in increased amounts. Basically a waste product, excess uric acid is a leftover. It enters your system after your body has absorbed all the energizing fuel it wants from meats and other foods. The excess is supposed to make a rapid migration to your kidneys, and they’re supposed to siphon it off to the outside world the next time you get the urge to go.
People who develop gout, however, get in a nonproductive wrestling match with the flow-through of uric acid. Either their kidneys can’t handle all the acid in their systems or their kidneys don’t do a good job of flushing away normal amounts. Either way, uric acid builds up. Over time, it crystallizes and finds a resting place in your lower joints, says Jim O’Dell, M.D., professor and chief of rheumatology and vice chairman of the department of internal medicine at the University of Nebraska Medical Center in Omaha. These crystals are annoying. And your joints, very annoyed, rebel by swelling up, getting tender, and hurting like—well, just an awful lot.
In men, gout problems tend to surface in the midforties. But because of changes related to menopause, gout hits later for women, usually striking when they’re in their midsixties, says Dr. O’Dell.
Some people get gout, some don’t—but the selection process is more than random. Family history plays a role. If your grandpa had it and so did your mom, you’re at greater risk than the gout-free family next door.
There are also dietary factors. Some foods such as meats, anchovies, mussels, and especially alcohol create a lot more uric acid than others. If your body can’t shed the excess, you’re being set up for gout every time you eat these foods.
Your first gout attack may feel like a throbbing pain that suddenly flares up, usually just after you get out of bed or during the middle of the night. If you’re lucky, you may never have another attack. Chances are, however, that you’ll feel this pain again within six months to two years. And if you don’t treat the problem, the attacks will grow longer and more frequent.
Half of people who have gout feel it in their big toes, though their ankles and knees also may be affected. Despite the pain it inflicts, gout itself is not a fatal disease, says Dr. O’Dell. The trouble is, it’s strongly linked with certain more serious problems like high blood pressure, diabetes, kidney stones, and high cholesterol. So when you’re seeing the doctor for pain relief, you may also be checked out for these other problems.
But once you have the doctor’s diagnosis and advice, you’re on your own. Here are some gout resisters that might help make the road smoother for you.
Try This First
Cool it down. When an attack flares up, reduce pain by packing your toe in ice, says Nancy Becker, M.D., rheumatologist in private practice in Kansas City, Kansas. Loosely fill a plastic bag with crushed ice and wrap a towel around the bag. With the towel between your toe and the bag of ice, apply this compress all around your toe. Use the ice pack up to three times daily, leaving it in place for 20 minutes during each treatment.
Other Wise Ways
Take an anti-inflammatory. Your pain is mostly a result of swelling. So over-the-counter anti-inflammatory medication such as ibuprofen may be helpful. Just make sure to let your rheumatologist know what you’ve been taking, says Dr. O’Dell. Anti-inflammatories can mask some of the symptoms of gout, making an accurate diagnosis more complicated.
Ban alcohol. Alcohol boosts your uric acid production. Stay away from the stuff, and you’ll help manage gout, notes Dr. O’Dell.
Repudiate purine-rich foods. Foods rich in a substance called purine can elevate uric acid levels. Fortunately, the foods you usually have to reject are also bad for your heart health, so you have a twofold reason to shun them. Try to cut back on the following: organ meats, anchovies, consommé, gravies, herring, mussels, pork roast, poultry, roast beef, and sardines, suggests Dr. O’Dell.
| Managing Your Meds People with gout who also have a circulatory disease may have a problem because some of the medicine used to manage heart disease, such as diuretics like chlorothiazide (Diuril) or furosemide (Lasix), can raise uric acid levels, says Richard S. Panush, M.D., chairman of the department of medicine at Saint Barnabas Medical Center in Livingston, New Jersey. If you have a doctor for a heart condition and you see a rheumatologist for gout, be sure both of the doctors know what you are taking. Side effects to the commonly taken gout medications include: • Diarrhea • Itching • Nausea • Rashes • Stomach pain • Vomiting |
Maintain a healthy weight. If you are over your ideal weight, you’ll have higher levels of uric acid in your blood that may lead to more frequent and intense gout attacks, says Richard S. Panush, M.D., chairman of the department of medicine at Saint Barnabas Medical Center in Livingston, New Jersey. Being overweight can also put you at higher risk for heart problems. Slowly but surely, lose those pounds, and you’ll stack the deck in favor of fewer gout attacks.
Keep your toe in the water. Dehydration can trigger a gout attack. Whenever you drink plenty of fluids, especially water, you’re activating the flush-out process that helps get the uric acid into your kidneys and then out of your system, says Dr. Panush. Make sure to get eight or more tall glasses of water every day. An easy method is to carry around a water bottle and take frequent sips.
