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I am a 50 year old woman, weigh about 102 lbs and I'm 5' 2″. I was just diagnosed with gout this past Monday. It all started early Sunday morning when I woke up with this awful ache in my left big toe. I couldn't walk very well the minute I woke up. As the day went on, it quickly got worse. I slept 3 hours that night. Monday morning I could barely put on a shoe. By 12:30, I was in a doctor's office. She prescribed Hydrocodone. I almost didn't fill the script….I'm glad I did because the pain was beyond anything I've ever felt! Tuesday, I was using crutches to get around. I called the doctor again, she prescribed Prednisone. After my second dose, the pain has decreased significantly. The swelling is still there (it feels like I have a small football on my foot). When will the swelling go down so I can wear a shoe? I have to go back to work ASAP (I am a bank manager and wear business suits).
I rarely eat beef (once a week…maybe). I eat chicken 2 or 3 times a week. I love lentil soup (have it quite often). I recently had split pea soup over several days. Also, I might have 4 or 5 beers a week (I like darker beer like Killians). I need comments about the swelling and my diet!!!
Hi K- Just caught your post . For a quick reply right now- The swelling can typically last a week at least and double that for taking care with what you do- to stop repeats.
Diet info abounds on her/online- but many support meds for aggressive cases and something to be said for this ,if you have a busy work schedule and need mobility at all times.
Stress is a big factor in gout and BP may need checking too.
Colchicine is the drug of choice for relief in the early days- while repeat attacks are awaited to gauge how persistent the gout will be. It won't let go easily, though. Painkillers can wear off and have side effects, if strong enough to work in gout.
Water intake in repeat small measures during the day is a must from now on.
I find sandals invaluable [have some under the desk] – but for formal work you will have to research the specialist shoe market for easing pressure.
I hope you are getting over the immediate attack now- but it does need time.
Is this your FIRST attack of foot pain or have you had bouts of unexplained pain before, usually starting on awakening, in your instep or ankle?
I think that colchicine is by far the best drug for an acute attack because it interrupts the attack where it is happening probably by alkalizing the joint.
The good news is most early attacks lasst about 3 days to a week…
Are you any better today?
Now that I think about it, for a couple years now, my ankles are sometimes stiff upon getting up after sitting or laying down for awhile, especially in the morning. This is only once in-a-while. Also, a few days before this attack, I noticed that all my toes ached. I chalked this up as the old age thing!
These past few days, I've been drinking water like crazy. I'm going to get some concentrated cherry juice. I don't know what else to do because I was a very healthy eater to begin with. Perhaps I eat too many lentils, peas, asparagus, whole grains….and I'll have to cut out my 4 beers and 3 glasses of red wine per week. I drink green tea, black tea and 2 cups of coffee every day….I hope this is still OK.
I am much better today…the knife stabbing into my joint has gone away. The swelling is still there though; I can at least walk on the outer edge of my left foot without using crutches. I just have to find something I can wear so I can get back to work.
My recommend is to forget the beer till you are better balanced on the gout front.
I get away with a few wines occasionally- up to a bottle even 🙂 but can feel the effects on joints. Ensure extra water at these deviating times.
Other drinks are supposed to be OK but my exp. is to 'get alkalizing' on food stuffs- as well as low purine.
No guarantee here- but it can be a big help.
Have you been offered/asked for Colchicine?
You probably won't be offered SUA lowering meds., one attack in- so this sharp starter attack [not always the case] has given you notice about getting on top of the situation early.
I've never found cherry juice that specially effective, though raw cherries are great if you can get them- but Black Bean Broth [see here- big thread] is definitely helpful in knocking back an attack for me.
.and I'll have to cut out my 4 beers and 3 glasses of red wine per week.
Definitely! Complete abstinence from alcohol is probably the single most important thing you should do now, closely followed by a drastic reduction of protein in your diet: no meat, lentils, pulses, nuts etc. You probably think I'm exaggerating, but until you are on urate lowering medication (which could be a long, uncertain process of tests and consultations), you will be extremely vulnerable to further attacks from anything that contributes to production of uric acid.
You might actually be better off sticking with crutches; very often the compensations you make to attempt walking differently can kick off gout attacks or cause tendonitis around other joints (ankles, knees & hips) which aren't used to bearing the weight in this way. This is common even in non gout scenarios.
The urge to return to “normal life” is strong at the beginning of this condition, but it has probably taken you between 20 years to get to this point, and any incipient recovery is really only like the tip of the iceberg temporarily sinking below the surface of the sea.
The more I read the more terrified and confused I become
Will I be back to square one or worse once I'm done with my prednisone (5 days)?
Allopurinol and Colchine (can we get this in the US?) seem so scary.
I was reading through the food tables and was confused about some foods:
-Raisin Bran is very alkaline…..I thought you're suppose to stay away from bran.
-Cheese is high in acid…..I thought this was much lower than beef or chicken.
-Chicken seems to have higher acid than beef.
-Beans seem to be more neutral, however, I was told to stay away.
The science on gout just doesn't get done, at least where diet and lifestyle are concerned.
It can be quite frightening to be in such pain so suddenly and everyone who should help looking rather blank- or at best indecisive.
Also, as a metabolic disease, naturally ones metabolism comes into it and everyone is slightly different on this point- that's what makes us wonderful
Rough rules are :
Stay away from meat and high [non veg] purines.
Dairy is OK, whatever the acid load.
Bran is necessary for health -and I don't see it as a problem myself keeping to Spelt.
Beans are loaded with purines. [beer=yeast]
It's a balance thing!
You must learn what does for you- or take meds., eventually. Simples!
Water.
When it comes to gout, K, very little makes sense. The diet issue is possibly the most confusing of all. Like me, you appear to eat healthily and then suddenly – bam – you have gout. Where did that come from ? When reading through what you can and can't eat all your favourites appear in the 'Can't' camp.
In reality, everyone seems to react differently to different foods. Some seem to have a reaction straight after eating only a small amount of a foodstuff, others have little or no reaction to it. For most, it tends to be trial and error. My own view after having my third and worst attack was to take things easy for a time while I got better, then reintroduce foods and drinks into my diet and see how it went. The worst culprits do seem to be seafood, meat and beer. Though some vegetables and lentils and so on often appear in the risky category, most research suggest they are safe. But try things out and see if you have a reaction, though be careful as its possible you may blame the wrong thing.
By the way, do you know what your uric acid level is yet ? Just how high is it ?
I debated whether to start allopurinol for several months before starting. Usually, the advice after only one attack is to wait and see how it goes. It could be years before you have another. A period of 10 years went by with only 3 attacks for me – in the end I started allopurinol as symptoms went on and on after that 3rd attack. I'm still finding the correct dose for me on the drug, but I've had no issues at all with it – its usually a very well tolerated drug. My view is you should remain open minded; hopefully your pain will soon subside. Have a blood test to see what your uric acid levels are, make some changes to your diet by all means, and who knows – that may be enough for you.
K
Get your uric acid tested ASAP now that this attack is waning. If it is high enough, then get on allopurinol (yep available in the U.S. for $4 a month at Target, Costco, or Walmart.) Same for colchicine…at least until the “patent protection police” get to it.
If uric acid is NOT too high, then you can wait and see if more attacks occur. You can try adjusting your diet, although all those tables seem like gibberish to me also. But to each his own.
I can attest to ONE thing about cherry juice though…it is absolutely DELICIOUS if too pricey for me.
No, I don't have my uric acid numbers yet. I finish the prednisone this Monday. The doctor said once the swelling/attack seems to be over (pain is already gone-just feel a little pressure from the residual swelling), she'll do extensive blood tests.
How soon do you know that a food is affecting you in a bad way? What is the “feeling” or “twinge” that I should expect that may turn into an attack? Before this first attack, all my toes on both feet felt funny/kind of achy for about 7-10 days.
I finally had my blood test on May 28th. My Uric Acid level is 4.4 mg/dL. My first and only attack was on May 1st. I was prescribed Hydrocodone for the pain (took 3 doses on May 3rd and 4th). I was prescribed 6 days of Prednisone starting May 4th. No other medication. As a matter of fact, Gout wasn't even the subject with the doctor. She highlighted my TSH (thyroid) 4.87 uU/mL and my White Blood Count at 3.9 Th/mm3 (just below the normal range). She didn't comment on my Monocytes….10.7 (high).
I'm not sure how to take my Uric Acid number. My left big toe joint feels fine. The only food I haven't had in a month is lentil soup. I've had sips of beer and wine only within the past two weeks and still hardly ever have beef……no twinges.
I'm concerned about my weight though. I've dropped 5 pounds…down to 97. I've really just added more yogurt, fruits and vegetables (I ate alot before). Any comments or help would be appreciated.
Your low SUA seems to suggest it's not gout. One low reading doesn't entirely rule it out though. Looks like you're in the zone of uncertainty, I'm afraid, in which case joint fluid aspiration would be the only certain method of confirming gout or not. Your Dr would probably be unwilling to recommend this, at this stage, and is understandably more interested in your possibly underactive thyroid. High monocytes would not be unexpected with a bout of inflammation. Watch & wait.
K.
Have another uric acid test this month and see if you can get confirmation on that 4.4 reading. If you DO get another one that low, then gout is probably off the table as a diagnosis.
Labs make mistakes, uric acid falls during an attack, cold acidic joints precipitate urate at much lower levels (although cold is rarely a problem in June in the NOrthern Hemisphere, etc. so another test is the wise choice.
If you DO get another attack after another low uric acid reading, then you and your doctor have no choice but to do a joint fluid biopsy to look for crystals, as odo said. If you get a HIGH reading then my advice is either to wait for ANOTHER attack or start now on allopurinol, 300 mg. If you get another low reading and an attack, or yopu find NO crystals, then the pressure is really for a good differntial diagnosis in the absense of gout…that is never easy.
I know, DOUBT is often worse than the disease…except for a full blown attack that is.
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