Does the pain ever entirely go away?

Whoohoo. No replies yet...just kidding. Talked to the Dr office. They said my uric acid levels from my blood tests were very low (but of course that doesnt mean anything). They did ask me if I drank more alcohol lately because some of my liver enzymes were up. Overall they said nothing seemed startling though.

cjeezy

Sorry to hear about your pain. I know exactly what you are going through, having experienced it myself.

I don't know why docs insist on testing blood uric acid levels for gout diagnosis when the results are not definitive at all. What is definitive is the examination of aspirated joint fluid under a polarizing microscope. You probably have to see a rheumatologist to get that test done.

Much has been discussed about the effect of diet on gout. Recent studies have shown that the effect is small.

What can have a very profound effect is sleep apnea, particularly when your attacks start while you are asleep. If you want, I can tell you the physiologic reason for the connection. But my main point is make sure that you don't have sleep apnea. Gout is an early warning of that condition which, if left to continue, can greatly increase your risk for the development of many much more serious conditions. Make sure that you don't have sleep apnea. You may have to be very persistent with your doc to be referred for sleep apnea testing because most docs do not yet realize that gout is an indicator of sleep apnea. Furthermore, because of your age and lack of obesity, you don't fit the stereotype for a person with sleep apnea, which is the same as for a person with gout.

Good luck.

Thanks for the reply! I've thought about a few things over the past couple days and want to clarify them. 2 days before my most recent attack (which was 2 weeks ago), I started noticing a tenseness in my big toe (ball joint) when I would lift it up. It didn't hurt, but it was like the tendon was VERY tight and tense. Then, 2 days later, the pain came in the middle of the night! Originally the ER gave me hydrocodone and Prednisone to treat it. After about a week it started feeling much better (still had light pain though). Anyways, I went to the park at this point and walked 2 miles. The following morning, the pain was entirely back again so I went to a local clinic.
On a side note, I recently started playing softball and have been running full speed when circling the bases...which I haven't sprinted like this in years. I'm now on Prednisone 20mg 2/day for 3 days, indocin 75mg 1X/day and hydrocodone 4X per day. I have to call the Dr back on Monday as he said he may want to do an MRI. Here are some things I now wondering.
1. Could I have sesamoiditis and not gout?
2. Even though xrays came back negative, could I have a fracture?
3. I do not think the Prenisone or Indocin is working at all. My pain goes away (while sitting and rsting only) when I take a pain killer but it seems to come back as soon as the pill wears off. I always have some pain when I'm walking and have been limping pretty bad now for nearly 2 weeks.
4. I started taking cherry and celery pills daily and now am drinking lots of water with 1-2 tsp of baking soda per day and this doesn't seem to work either.
5. My diet over the past week has also consisted of very low purine foods
6. Originally (when I first started having symptoms) before I knew what gout really was, I drank some beer and the pain never got worse

Any thoughts? If this was gout, shouldn't I have noticed at least some relief by now? Does gout get worse if you walk on it? Your input would be GREATLY appreciated! I think if the pain continues on Monday I'm going to insist on a joint fluid test just tto put my mind at ease and know for sure. the pain is still horrible today without pain meds!

Man, Don't know what the point of this site is if no one ever responds. ANyways, symptoms are calming down slightly today after soaking my foat in hot water. I am going to try and schedule an appointment with a podiatrist to have fluid drawn just to put mind at ease.

Cjeezy, I promised myself if ever I found someone as confused and frustrated as I was I'd throw out some help. Your story is very similar to mine. 2 1/2 years prior to a big gout attack I was getting the same situations and conditions. I'm a ski and mountain bike fanatic and I'd get the same "big toe" pain and then sometimes in the heel but only for a few days. I also hit the ER at one point for an X ray and they said there was no fracture. Take Ibuprofen and stay off of it was the advice. Trips to 3 different general practitioners and a foot specialist only came up with the same answers......Planters Faciutus and Mortons Nuroma. Their recommendations were orthotics and Ibuprofen. finally..... I really got hit hard.....first the left foot, then the right. I swear if even the air from the ceiling fan hit my foot I would cringe.

Here's the deal.......you can second, third, and fourth guess whats going on......have a doctor check Uric acid levels (doesn't really mean anything) and the fluid test by sticking a needle 1-2 inches into the joint of the big toe? My doc studied at John Hopkins and worked at the Mayo Clinic for years.......he got the job done and then said " you have gout....take this Allipurinol and come back in 3 months"

I paid my dues through study on the internet.

1) Read through the website called Gout Cure.com....best education you'll find on the subject. Promise I don't work for them but order the Gout Care product, Probiotics, and Booster vitamins (not expensive) Also have them send along the pamphlet which explains whats going on and a 7 day kick start diet that you will wean yourself off of after day 7.

2)Back off of alcohol completely during the diet. I know beer and softball go together....just don't use it as a food group until you're in the clear

3) Keep doing the things you mentioned above in #4 and #5.....especially the baking soda....take 1/2 teaspoon mixed in water only in the morning and before you go to bed. The idea...same as with the diet....is to get your system alkalized. Uric acid is natural to everyone but you have a lot of crap in your system. Your liver is working on the bad stuff so hard it's letting too much uric acid through. When you take the baking soda at night it works while you sleep and in the morning it starts you off fresh.

4) I picked up Colchocine when it hit me the hardest and it was helpful but not the complete solution

5) Western medicine seems to be baffled by gout and they want to "mask" the solution....For the first time I tried old school acupucture and Chinese herbs to finish off the attack.....really seemed to move it along quickly. Think about it....they have treated gout thousands of years before Western medicine started to advertise "take a pill for everything" in our media.

6) Lastly....have a lot of patience! Eveyone is different.....first attack goes away quickly but builds up to what you're experiencing today. I've since met 9 people in the small community I live in that have had it and they all have a different story....the real deal is to educate yourself.....get it under control....know good and well if you change a few things in your life you may never have another attack again!

Thank you for your response and feedback. It doesnt seem like there is a lot of traffic to this particular forum. I have some Dr appointments this week (I'll post update later). Yesterday I bought some Ph strips online to monitor my levels. For me, the not knowing what it is is killing me. Yes it sounds like gout but there's no definitive proof yet. I'm going to insist that my Dr performs a fluid test to be certain just because I dont seem to fall in the "typical" demographic. Did your Dr finally conduct this test to diaganose you? I stayed off of it for 4 days last weekend and it started feeling better...then bam as soon as I started the work week Monday it flaired up again from walking on it as well as due to my dress shoes. Today I'm wearing a low soft-soled shoe which feels a little better but not much. Thus far, 1 week on BS, cherry juice and celery seed and nothing (as well as 2 weeks on Rx). Not sure if the 75mg of Indocin is too low of a dosage or maybe I need to be on Colchocine. I guess I'm just "hoping" that it is sesamoiditis or something similar. I know wishful thinking, but you never know I'm trying to be patient, but it's hard when this is starting to put my job at risk. Is the second attack typically the worst? I don't know what else to do to prevent this from happening again. I'm trying to be patient and with the exception of a couple meds I havent been prescribed yet, I'm doing everything I can but nothing seems to be working. I visited the goutcure.com site and they have quite a bit of useful information. The only thing that I'm having a hard time understanding is "what can I eat?" The site says to avoid the following foods...which is basically everything!
ACID FORMING FOODS FATS & OILS
Avocado Oil, Canola Oil, Corn Oil, Hemp Seed Oil, Flax Oil, Lard, Olive Oil (when heated), Safflower Oil, Sesame Oil, Sunflower Oil
FRUITS
Cranberries
GRAINS
Rice Cakes, Wheat Cakes, Amaranth, Barley, Buckwheat, Oats (rolled), Quinoa, Rice, Rye, Spelt, Kamut, Wheat, Hemp Seed Flour
NUTS & BUTTERS
Cashews, Brazil Nuts, Peanuts, Processed Peanut Butter, Pecans, Tahini
ANIMAL PROTEIN
Beef, Carp, Clams, Fish, Lamb, Lobster, Mussels, Oyster, Pork, Rabbit, Salmon, Shrimp, Scallops, Tuna, Turkey, Venison
PASTA (WHITE)
Noodles, Macaroni, Spaghetti Distilled Vinegar, Wheat Germ
BEANS & LEGUMES
Black Beans, Chick Peas, Green Peas, Kidney Beans, Lentils, Lima Beans, Pinto Beans, Red Beans, Soy Beans, Soy Milk, White Beans, Rice Milk, Almond Milk
DRUGS & CHEMICALS
Aspartame, Chemicals, Drugs (Medicinal), Drugs (Psychedelic), Pesticides, Herbicides
ALCOHOL
Beer, Spirits, Hard Liquor, Wine
ACTIVITIES
Overwork, Anger, Fear, Jealousy, Stress
Moderate Acid - pH 6.0 to 6.5
Cigarette tobacco, Cream of Wheat (unrefined), Fish, Fruit juices with sugar, Maple syrup (processed), Molasses (sulphured), Pickles (commercial), Breads (refined) of corn, oats, rice & rye, Cereals (refined), corn flakes, Shellfish, Wheat germ, Whole Wheat foods , Wine , Yogurt (sweetened) Bananas (green), Buckwheat, Cheeses (sharp), Corn & rice breads, Egg whole (cooked hard), Ketchup, Mayonnaise, Oats, Pasta (whole grain), Pastry (wholegrain & honey), Peanuts, Potatoes (with no skins), Popcorn (with salt & butter), Rice (basmati), Rice (brown), Soy sauce (commercial), Tapioca, Wheat bread (sprouted organic)
Extremely Acid Forming Foods - pH 5.0 to 5.5
Artificial sweeteners, Beef, Carbonated soft drinks & fizzy drinks , Cigarettes (tailor made), Drugs, Flour (white wheat), Goat, Lamb, Pastries & cakes from white flour, Pork, Sugar (white) , Beer , Brown sugar , Chicken, Deer, Chocolate, Coffee , Custard with white sugar, Jams, Jellies, Liquor , Pasta (white), Rabbit, Semolina, Table salt refined & iodized, Tea black, Turkey, Wheat bread, White rice, White vinegar (processed).


Thank you again for the encouragement!

Went to my family doctor today. Here are some of the points he discussed with me:

1. He would not be comfortable nor would he do a joint fluid test because based off of my experiences, xrays, symptoms, etc he was 99.9% sure it was a gout attack. When I asked him if there was any chance it was something else he said "no."

2. My lingering symptoms are most likely caused from not resting it enough.

3. He said he has many gout patients and everyone is different. Some people only have attacks every few years, some every month and some only a couple times in their lives. I will just need to keep an eye on my flare ups in the future.

4. He said that he even developed gout about 7 yrs ago when he was 40 yrs old. He said it lasted him a few days, but took over 3 weeks to completely heal. He said to this day he is still able to eat and drink what he wants...hence everybody is different and has different gout "triggers."

5. He told me to finish my 15 days of Indocin, wait a month after I am completely healed (whenever that will be), and slowly easy back into my normal life. He said if I have another bad attack in a year, then he would want to bring me back in to discuss Allipurinol.

Any thoughts on all of this?

I'm going thru something very simular right now. It seems like you have a lot better understanding of this deal than I do. thanks for your sharing experience

cjeezy,

How does your family doctor know that your symptoms indicate gout, and not pseudogout? The symptoms are very similar, but pseudogout is caused by calcium-based crystals in a joint rather than urate-based crystals. The recommended treatments for the two conditions differ greatly. I suspect that the reason your doctor refused to aspirate your joint fluid is that he doesn't have access to a polarizing microscope, which is needed for the differentiating analysis.

He didn't mention the 2 types of gout to me. I was under the impression that pseudogout typically does not start in the foot? Also my UA level was 8.1 during their test.

HWT: My Dad had gout. He was on a restricted diet and had to take pills every day.

Over the years I would have occasional spells of unexplained back pain; stay in bed for a day or two and they would go away. Then when I was about 65 I had a swollen and painful ankle. Was scheduled to leave that night for Christmas with relatives about 600 miles away. Shoved the feet into ankle-high boots and drove anyway (not macho-man, but a man, nonetheless). Got back about 10 days later and everything was close to normal. When I saw my Dr. he told me to come in the next time and he would pull fluid from the joint.

I figured I didn't want a next time so I hit the internet and came up with the thought that lots of water would keep the uric acid flushed out, so that it couldn't accumulate. I found relief and have kept attacks away with 4 liters a day. Got a 2.5 gallon Brita and four reusable water bottles (makes it easier to keep count). If I fall down to only 3 per day I can start to feel a joint trying to act up. If I'm too busy and wait until it becomes obvious I need to go to 5 liters for a couple of days to get uric acid levels back to where I want them. I can then resume my 4 liters/day routine. Ps: lots of potty trips in the evening and have conditioned my body to wake up, empty the bladder, and go back to sleep about 3 times per night.

Water is basically free and avoids drugs or highly restrictive diets. I do however, try to limit my intake of the 'high-purine' foods. It'll cost you nothing to try; give it a week and move to something else if it doesn;t work for you. However, the logic is pretty sound and it follows the KISS principle - Keep It Simple Stupid. Ought to work for pseudo-gout also, since it is the same basic problem - buildup of too much of something.