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The 3 Stages of a Gout ATTACK.

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If you have gout, you will have gout attacks and all of these attacks will occur in three stages. The sooner you end a stage the sooner your gout attack will be terminated. There are many remedies (foods to avoid, exercises, drugs, etc.) offered by gout sufferers, which may or may not work for you. If they do, great! But, once you do start to get a gout attack you will need to treat yourself as in Stages-1, 2, and 3 below.

Stage-1 Treatment:
Is applied when there is only slight pain, typically numbness, in your joints, toes or Achilles tendon.
At this point you should only use trigger point therapy. Drugs may seem to help, but they will hide the trigger point referred pain, which is your only indicator of where to massage. If you do not massage away the trigger point at this stage it will progress to stage-2 and greater pain. You must find the trigger points, based on your pain and massage/eliminate them. It may take numerous massages of each trigger point a day over a few days. After a while you will know which trigger points to erase in future stage-1 gout attacks, which will happen if you tend to get gout attacks. Be careful, you can easily slip from stage-1 into stage-2 if you are not aware of your pain. If you have pseudo-gout pain then this is the only stage you will have and the one where you will relieve your pain.

Stage-2 Treatment:
Is applied when there is greater pain in your joints, toes or Achilles tendon accompanied with mild inflammation due to synovial fluid trying to lubricate the painful joint.
Use trigger point therapy as in stage-1, but also take ibuprofen or other anti-inflammatory pain relievers as prescribed. You need to stop the inflammation at its start. Frankly, I use about twice the suggested dosage since the suggest dosage doesn’t do anything for me, but you know your own body and should do what works best for you. It will take numerous massages and anti-inflammatory drugs every day for many days to relieve the swelling. Big toe or other joint pain is usually easy to stop in stage-1 or stage-2: unfortunately, when the attack starts with a stiff or painful Achilles tendon, you need to work very hard to eliminate the calf trigger points to keep from progressing to stage-3. You may need to massage each of those calf trigger points for about 30 seconds each 4-6 times a day until your Achilles tendon is functional again. A note about alcohol, it will eliminate the effects of Ibuprofen so if you drink, don’t expect to reduce the inflammation until you stop drinking. Be careful, you can easily slip from stage-2 to stage-3 if you are not diligent about your stage-2 treatment.

Stage-3 Treatment:
Is applied when there is severe pain in your joints, toes or Achilles tendon accompanied with swelling, heat and darkened red skin from fluids infiltrating the painful area making it even more painful.
Continue your trigger point and anti-inflammatory drugs therapy as in stage-2. Unfortunately, if the attack gets to this stage you are in for a long painful rehabilitation of 2-6 more weeks, longer if the Achilles tendon is involved. You will need to massage your trigger points many times a day to reduce stage-3 into stage-2 and then a stage-1 before the attack is over.

Please Note:
Gout attacks go from a stage-1 to stage-2 to stage-3, but also goes from stage-3 to stage-2 to stage-1 during treatment. When you get back to stage-1 it is best to continue with stage-1 treatment (massaging known trigger points) for a few days or a week after ALL of the pain and swelling is gone. This will assure you that you don't automatically transition into another gout attack because the present trigger points aren't fully eliminated.

Commentary: I am presently at the end of a stage-3 attack (that I allowed to get to stage-3) and have resolved it in a total of 20 days. In the past, before I discovered the 3-stages of gout attacks, I would transition right into a stage-3 attack that would last from 29 to 51 days. This time, since I resolved my big toe problem in stage-1, the toes never got to stage-3 or even stage-2; not so with my ankle and foot and until I found the trigger points for my Achilles tendon which helped to stop the attack. I did though; have to massage the big toe trigger points throughout the 20 days to keep them from getting to stage-2 and eventually to stage-3. The ibuprofen helps with the inflammation (as does compression socks), but the inflammation continued to progress until all of my trigger points were erased. Packing the red, inflamed area with ice (or putting my foot in an ice bath) helps to reduce the swelling/pain momentarily, but it comes right back if I don’t rid myself of my trigger points Trigger points cause inflammation and inflammation causes trigger points. In the past, the excruciating pain drove me to stab the severely swollen area with a utility knife to squeeze out the fluids and white tophi. Unfortunately, even though it helped reduce the swelling, it lead to a systemic infection and other problems. My physician used a syringe to remove some of the fluids, after which I purchased my own syringes, etc., to do it myself. Happily, I haven’t had the need to do this for the past two years since I now stop my attacks at stage-1.
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