You’ll do more than shout when you experience the pain from gout. In other words, you will “go-out” of your mind.
I don’t know how many times I have gone on a house call when I have found a patient looking like death warmed over because of pain in a swollen, large red toe resting outside of the covers. Often, the patient will tell me that they have tried everything to get rid of the pain, to no avail. They have taken aspirin and other pain-killing drugs and have only experienced upset stomachs without relief.
Oh. By the way, a lot of these over-the-counter pain-killing drugs can cause ulceration of the stomach, leading to bleeding. If, by chance, you notice your stools becoming black, this discoloration is evidence of internal bleeding in the stomach.
To me, when I see this painful joint that has not responded to any therapy, most likely the diagnosis is gouty arthritis. I am further convinced when the patient has a history of diabetes, hypertension or chronic kidney disease. If they’re taking a water pill, such as a thiazide diuretic, the diagnosis of gout becomes more evident. Certainly, a family history of gout is a red light of suspicion. A heavy diet of red meat and other organ meats is another signal of this diagnosis. A history of excessive alcohol use may also be the cause of gout and lead to an acute attack.
Gout is caused by an increase of uric acid that finds its way into joints causing inflammation, swelling and, oh lord, the pain. It appears that men suffer more from this condition than women. Examination of the patient often reveals deposits of uric acid crystals along the border of the ears. This deposit also causes disfiguration of hands, toes, ankles, wrists and knees.
If a blood sample is taken during the acute stage of the gouty attack, it may be found to be normal. This finding should not rule out gout. The optimal time for taking a uric acid level is “two weeks after a flare up is resolved.”
There are several drugs that can be prescribed to prevent the buildup of uric acid. However, a diet low in red and organ meats such as liver, kidney, etc., may prevent symptoms.
Upon viewing the large, painful joint and the mask of pain on a patient’s face, I know that they need relief immediately. I usually will prescribe the following: A drug that I find most useful is colchicine. This drug is derived from a plant and has been used for years. I usually recommend that the patient take one tablet every hour for five doses. If nausea or diarrhea occurs, stop the medication. This pause allows the level of the drug to provide therapeutic relief. The patient is then advised to take this medication twice daily until symptoms have subsided. Often, during an acute attack, a steroid such as prednisone may be prescribed to reduce the inflammation.
The shout from gout can become a lullaby if treated aggressively. By all means, consult with your physician if you are experiencing this type of joint pain and over-the-counter medications do not give relief.