Gout is `in' disease but toe can be healed
-Toronto Star, JUDY GERSTEL
Jun. 24
Remember Men in Black?
It was a movie starring Tommy Lee Jones.
Now read about Men in Pain.
It could be a sitcom, maybe even starring a man you know.
I heard about a man who, when he was in pain and kind of panicky, insisted
from the moment he shuffled through the Emergency Room door that the woman
who accompanied him and whom he was seeing at the time, should be presented
to hospital staff as his wife.
Probably he figured that as wife, she'd be able to stay with him and
advocate on his behalf. Perhaps he also found the faux conjugality
comforting during his distress, in the way that soldiers find God in foxholes.
Then, after the man was out of pain and the problem was fixed, as he was
being wheeled out of the procedure room to the recovery area where his
companion was waiting, he introduced her to the surgeon as his girlfriend.
Men in Pain. There's no telling what they'll do. Or won't do.
Mostly, they won't do anything. They'll just try to pretend the pain isn't
there but, at the same time, that it will go away. (The existential
complexity of this conundrum inevitably escapes Men in Pain.)
Unless, of course, it's excruciating pain, aka agony.
Agony is what happens when uric acid crystals form in the kidney (stones)
or in a joint, very often the big toe joint where the diagnosis is gout.
It's an easy diagnosis to make.
A man hobbles into an emergency walk-in clinic late Sunday evening after
suffering agonizing pain for days, holds up his foot to show the doctor how
swollen and red the area is around his big toe joint and from behind his
desk, the doctor says, "Gout."
Then he asks the gouty man how long he's been suffering. The patient thinks
back to when he wakened in the middle of the night with a throbbing foot
the classic onset pattern.
Even the bed sheet against the inflamed, hot, stretched skin felt like salt
in a wound (so he said).
"Wednesday," says the patient.
"Fool," says the doctor, adding insult to injury.
The fool gets a prescription for Voltaren, the brand name of diclofenac, a
non-steroidal anti-inflammatory and one of the NSAIDS widely used to treat
the inflammation, pain and swelling of arthritis. Gout is actually a form
of arthritis.
And it's becoming a lot more common as baby boom men advance to the age of
gout.
Men, according to the Arthritis Society and other sources, are at least
four times and as much as nine times more likely to develop gout than women.
(Do not for a moment think that I am actually enjoying writing about
something that causes excruciating pain and disproportionately afflicts
middle-age men.)
About 1 in 30 Canadians has gout. In the U.S., about 3.4 million men have
the disease, reported The New York Times this week, in a feature about
gout, making the fool with the swollen red-hot toe feel very au courant as
he swallowed his pills and rapidly began healing.
A gouty foot used to be something of a badge of honour because it was
thought to be a result of eating too much rich food, including caviar, and
red meat foods peasants couldn't afford. These also happen to be high in
an amino acid called purine, the culprit in causing uric acid deposits.
Gout was called the disease of kings and limned by poets, many of whom
suffered from the affliction which was always thought to be, accurately, as
it happens, aggravated by alcohol, or, as has recently been shown, certain
forms of it.
Famous sufferers include Charlemagne, Henry VIII, Voltaire, Isaac Newton
and Charles Darwin. Even Hippocrates wrote about gout.
More than 300 years ago, philosopher John Locke proposed a diet low in meat
and high in milk, dairy products and herbs as a means to prevent gout,
according to Toronto rheumatologist and gout expert Dr. Adel Fam, writing
in the The Journal of Rheumatology. And for the most part, Locke was spot on.
Some recent, large epidemiological studies in the U.S. have done a lot to
dispel myths about the disease and offer guidance to sufferers.
Here's some of what's been reported:
Two or more beers per day increased the risk of gout two- to five-fold
compared with no beer intake. Two or more drinks of spirits increased the
risk by one to six times compared with no spirits intake. However, two
4-ounce glass of wine per day was not associated with an increased risk of
gout.
Foods rich in purine that should be avoided include red meat, especially
offal, including sweetbreads, liver and kidneys as well as seafood
shellfish, scallops, caviar.
However, high intake of animal protein such as turkey and chicken and
consumption of purine-rich vegetables (peas, beans, lentils, spinach,
asparagus, mushrooms) did not increase the risk of gout.
Increasing dairy products (milk, yogurt, cheese, ice cream) protects
against gout.
Genetics and obesity appear to be contributing factors to the risk of gout.
There's also medication (Allopurinol) that can be taken daily to help rid
the body of uric acid.
Meanwhile, Men in Pain from gout should know that swallowing a few
prescription anti-inflammatory pills will result in relief within hours.
They may also find it interesting and comforting to know that the uric acid
crystals causing the agony are identical to the white part of the bird
droppings they clear off their cars.
After all, Men in Pain need and deserve all the comfort they can get.