Tuesday, 15 February 2011

A bout de gout...

Well here I am in the throes of another bout of suffering and self-pity. What started out as a very slight discomfort in the first metacarpal of my big toe a couple of weeks ago, eventually grew somewhat falteringly into a full-blown inflammation of my right foot, with all its attendant agony - hopefully reaching its final crescendo last night.

For those who have never suffered the affliction of gout, when the pain is at its peak (which invariably comes on during the night), it manifests at several levels. There's an all-pervading throb that emanates from the swollen joint, radiant with inflammation: this totally saps one's energy and is impossible to ignore - like a nagging toothache. And then there's the searing agony caused by the slightest movement or involuntary muscle spasm. And just to add to the fun, the effort of consciously trying to keep absolutely still often brings on a simultaneous attack of cramp!

When at its peak, even the best pain-killers only seem to take a little off the edge of the pain, and it's quite natural to irrationally fantasise about how much better a prospect amputation would be...

And one of the most annoying things about the whole thing is that there are no external agents to blame for the suffering - it's entirely due to the failing of one's own body chemistry. What happens is that urates in the blood produced by the digestive system start to form uric acid crystals in the soft tissues of vulnerable joints, prompting inflammation. As the crystals grow, any slight movement of the joint makes them tear at the inflamed tissues producing excruciating pain. Uric acid is relatively insoluble and so once formed the crystals take several days to disperse even if/when the blood urate level has returned to a tolerable level.

Particularly galling for me is that the factors that normally render someone vulnerable to gout are: being obese (okay I'm slightly over the "ideal" range for my height-weight bell curve); eating too much red meat (I'm vegetarian); and drinking too much ale and red wine (I'm a moderate cider drinker). Indeed my blood tests have indicated a relatively innocuous level of urates relative to that normally associated with the condition.

So it seems I'm one of those rare unlucky people who's prone to gout even with relatively normal urate levels. The consequence of which being that the benefit of preventative medications (such as allopurinol) which act by controlling blood urates is likely to be of questionable efficacy for me.

I will treat this latest episode as an incentive to lose a little of my excess weight and cut down more on the alcohol, but can't really start on that til I'm mobile again and in the mean time I'll just continue to feel sorry for myself... :-(

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