Diagnosed Today (no tests)

[Max Rutherford]

Hey guys and gals. My name is Max and I’m 27 years old and live in the States. Very glad I found this forum, I look forward to reading and learning everything that this site has to offer.

Four days ago while I was working (very busy restaurant, on my feet all day) I noticed my left big toe joint becoming sore. This isn’t uncommon in my shifts, but that shift was particularly painful. I left my keys at my house so I had to walk home around 1am that night. While I was walking home, a car containing 3 people cornered me and pulled out what I thought at the time were guns. Turns out they were just BB guns, but my fight or flight kicked in and I started to run and I didn’t make it very far haha. I attempted to hop a median but ended up smashing my foot directly on the vertical surface of the median, causing me extreme pain and humiliation as these punks shot BB’s at me.

I ended up at home thinking I had broke my big left toe. I iced it, put liboderm patches on it, nothing was helping that night.

I woke up the next morning in the most extreme pain I have ever experienced. I’m a tough dude, I ride bmx, but this pain was unreal. It was almost hallucinogenic in its intensity. I attempted to nurse the pain for days in near tears, nothing was helping so I finally went to urgent care. X rays were taken with no fracture in sight, and the doctor immediately suggested he was going to treat me for gout. I was shocked. My father and mother’s father both have gout, so I knew it was a possibility I may at some point in my life get gout, but at 27 I thought there was no way.

His diagnosis made perfect sense. I was baffled in how much pain I was in and the symptoms I was experiencing. The swollen and hot to touch area made me think the small cut I received in the situation was infected. I started antibiotics and thought “good, I’ll heal up soon enough”. Again, I ride bmx bikes so rolling an ankle or jamming a toe is nothing new to me. Then the pain intensified immensely. I was taking (probably too much) acetaminophen and was having zero luck with that. I went through a ten pound bag of ice in a day, no luck either. Lidocaine patches were doing nothing as well. I was utterly confused. The doctor suggested I have gout and it all clicked.

I’m 6’2″, weigh 195, broad and muscular athletic body type. I was eating semi-healthy but I do drink alcohol at least 5 days a week.

The pain was surreal. I had no idea what was happening to me, complete confusion. My father is being very supportive in giving me tips in how he deals with his gout, however I’m terrified of the pain I’m experiencing and would be extremely grateful if knowledgeable people could point me in the right direction in preventative treatments and tips during future flare ups. I guess I just want to say hello, introduce myself and gain knowledge. This is the worst, worst pain I’ve ever felt and will do anything to prevent or at least treat this soul crushing pain. I’m at a loss.

Thanks,
Max Rutherford

[Keith Taylor]

Hi Max,

That’s a very dramatic introduction to gout!

Gout pain needs a package that tackles different aspects of the pain process. Gout pain stems from an immune response to the presence of uric acid crystals. That response produces inflammation that turns to “most extreme pain I have ever experienced.”

This is totally different from the nerve pain that Liboderm helps to block. There are some pain-blockers that can help gout pain. But these are best taken in rotation with anti-inflammatory meds. Even before anti-inflammatories, gout sufferers have a wonderful med called colchicine. This has been very expensive in America in recent years, due to licensing of Colcrys. You should now be able to buy cheaper colchicine from Prasco.

Colchicine is not a pain-killer. It helps us by tackling gout pain at its source – our immune system. It inhibits the immune system from starting the inflammatory response. It does nothing to reduce inflammation, and nothing to block pain. It is only useful if you take it before the gout pain starts. It is best used every day as a preventative taken at the same time as uric acid lowering meds. If you are not taking uric acid lowering meds, colchicine is still useful. Take one at the first sign of a gout attack. Take another in two hours if there is still any signs of a gout attack. Never take more than two in 24 hours. Never take colchicine if you have any infection, or if you are likely to be exposed to infection.

Anti-inflammatories are your best defense, but they must be gout strength. Personally, I believe you should only use steroids (prednisone, prednisolone, etc) as a last resort. I say this because they knock out your bodies natural anti-inflammatories. You should discuss this with your doctor if he suggests steroids. For people who cannot tolerate NSAIDs (Non-Steroidal Anti-Inflammatory Drugs), steroids might be the only answer. For the rest of us, gout-strength NSAIDs are the main weapon in our anti-gout pain arsenal. Get your doctor to prescribe maximum strength. OTC doses are OK for a gouty twinge, but they will not touch a full blown gout attack. Ibuprofen is my personal choice, and naproxen is also highly recommended. These NSAIDs are gaining popularity over Indocin, which has always been commonly prescribed in America, but is now seen as less effective for most people.

Please note, Max. There is no “best NSAID for gout.” Every gout sufferer reacts differently, so if inflammation persists, or side-effects are unpleasant, then ask your doctor to prescribe something else. What you are seeking is “best NSAID for Max.”

So we have up to 2 colchicine to stop inflammation spreading, and max-strength NSAIDs to reduce inflammation. Reducing inflammation will reduce pain. If, after two hours, pain is not tolerable, turn to pain-blockers. Your doctor or pharmacist can advise which pain blockers are compatible with your current NSAID. Most common, and usually most effective for gout is acetaminophen/paracetamol (Tylenol). Again, get a prescription for gout strength dose.

TL;DR
Colchicine to stop inflammation spreading. Max of 2 per day. Take at first twinge.
NSAID (ibuprofen, naproxen, indomethacin, or others) to reduce inflammation and pain. Max dose. Start at first twinge. Repeat 4 hourly up to max dose.
Pain Blocker (paracetamol, codeine, tramadol, or others) to block residual pain. Max dose. Start 2 hours after NSAID dose and repeat 4 hourly, if required, up to maximum dose.

That should get you dancing round the restaurant, Max. As a gout newbie, it’s a lot to take in. Please ask as many questions as you need to. Don’t be afraid of asking for clarification if I’m not clear. The more we discuss your gout, the better I get at framing my answers to suit you.

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