He was pacing in my waiting room, holding his red, swollen wrist and roaring at everyone like a wounded bear.
This normally jovial and mild mannered gentleman was suffering from an extremely painful joint affliction called “Gout.” As it was the week before Christmas, I doubted he would be the last patient with Gout this season: Gout is exacerbated by alcohol, fructose and red meat, seafood and certain fruit. He is typical of the classic person suffering with gout, being male, older than middle aged and with a few pounds to spare. A bit like Santa Claus. Gout is also more common in people with high blood pressure, Type 2 Diabetes and Psoriasis or kidney impairment.
As we peered together over a list of potential culprits, (click on the link: https://my.clevelandclinic.org/health/treatments/22548-gout-low-purine-diet ) his son quickly identified the the offender: “Dad it must be the Gummy bears. They contain Fructose.”
The problem is that these purine containing foods cause uric acid crystals to build up in a joint – classically the big toe joint as shown in the picture. Also commonly in the elbows, knees and ankles. Some people are also particularly at risk because they have an enzyme defect which means they cannot eliminate Uric acid as well as the rest of us, leaving the crystals of uric acid in their joints causing inflammation.
Some drugs can make this worse too: A non exhaustive list includes low dose Aspirin, some diuretics and some blood pressure medications. Just don’t stop these drugs without talking to your doctor first. You might end up with something worse than Gout if you do.
Keeping alcohol to a minimum, staying hydrated, avoiding lots of red meat or sugar and loosing weight can help prevent attacks of gout.
So what to do besides eating and drinking like a Puritan over Christmas?
Well, if you are unfortunate enough to be afflicted with an attack over the holidays, over the counter anti-inflammatories like Ibuprofen or Voltarin (Diclofenac) or Naproxen can help…Just make sure there is no good reason why you should not take these: a history of a stomach ulcer is one example. Some people with Asthma cannot take these medications either. If you are already on Aspirin for something else you cannot take anti-inflammatories because of the increased risk of bleeding. . However, in these cases, there are prescription drugs which can help during an acute attack. A bag of frozen peas over the joint to can help reduce the swelling too. Don’t leave it on for more than 20 minutes at a time. I like bags of frozen peas because they tend to conform to the shape of the joint better than ice packs. Just clean off the bag before opening it to add the peas to your Seven layer Salad on Ole Years Night.
Otherwise, if you tend to get recurrent attacks, we can give you a prescription drug to prevent gout.