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Sorry for the long post.
I am 37. This all started in 1998.? I was having back problems on and off, and I was back and forth between doctors, Pt Chiro etc.? They eventually said?( after MRI's) that I had 2 disk herniations, and my 4/5 disk blew out in 2007 and required a lumpectomy.? During all of this back and forth my family doc said my blood pressure was high, so he put me on 25mg of hydrochlorothiazide?in 2006.? In 2009 my back started acting up again, this time on the left side, and I was sent to a pain mgt doc who gave me steroid injections, and percocet.? Last year my left big toe started to hurt, and I was sent for x-rays that said I had slight arthritis, and sesamoiditis.? The pain continued in my back and toe, and I saw a orth. surgeon, who said I need a Lumbar spinal fusion at L 4/5, and L5/S1.? I have since sought out 2nd and 3rd opinions who confirmed this.? Now 3 weeks ago my entire left swelled and I was in agony.? My family doc sent me to the ER, thinking it may be a blood clot.? The ER said it was Gout and gave me colchicine(?), and more percocet.?? The swelling has gone down and I can put weight on my foot again, but there is still a lump at my big toe.? 3 days ago I went back to my family doc and got a blood test that said my Uric Acid level was 10.8.? My hydrochlorothiazide?was stopped and I was told to come back in a month to measure again.?
Could my disk issues in my back be related? Should I avoid the back surgery?
When will my toe swelling go down??
Should I see a specialist for gout, and what kind?
Will it go away on it's own now that i stopped hydrochlorothiazide?
I have tried to fix my diet, and stop soda (I don't drink alcohol).
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thanks for any help
Hi Forya- your post is not long. With gout, the more info the better [withinn reason]!
Technically, you haven't been officially diagnosed with gout? , but?stalwarts here will recognize?your story, rather too well.
The diurestics are classic gout inducers and, sorry to say, once got -never released, as a potential source of trouble.
The good news here, is whatever happens as a result of urate build-up can be dealt with one way or another.
Meds are the easiest and surefire way of dealing this and even if docs are slow to catch on induced illnesses they certainly go pensive when it hits the fan. Read my lips 😉 …
From this, remember that ALL meds can have unwanted side effects -so my view has always been gently on these and try diet and lifestyle changes first -and then in parallel.
In all honesty- with an SUA of 10 [with gout] meds are top of the list. People have reportedly taken meds for years and then weaning off and some use low doses [like me] to supplement hard learned methods to assist this.
Stopping HCT is a prime move, but can't undo the gout. Swelling due to gout?can go down in a week [or two].
With gout ANY joint is vulnerable and it may be wise to stablise this factor before looking further. Back gout isn't all that common afaik, but I had a Dr with a bad case -which went undiagnosed, too. [Yeah, I know!]
Good luck- I'm sure things can get better for you- gout is bad and can be depressing [NO wonder there]
Thanks for the reply.? I am going for a MRI on my back on Monday.? The diagnosis for my back so far is a severe herneation at L4/5 and moderate Degenration and sacral tear at L5/S1.? There wasn't any mention of arthritis, isn't that how Gout would appear on an MRI?
I hope the back is somehow related to the gout, so maybe I can avoid the 2 level Fusion that I am possibly looking at.
Maybe I can talk the MRI center into doing my foot too
? i doubt it.forya said:
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Maybe I can talk the MRI center into doing my foot too
? i doubt it.
Forget that. NO x-ray and NO MRI is going to show any MSU deposits. At this time, only what is known as DECT=Dual-Energy Computed Tomography? (a kind of a dual x-ray machine) is capable of that. And, unfortunately, I think, only ONE ?machine is here in the States and one in Canada.
Though MRI comes nowhere near DECT for diagnostic purposes, it will show uric acid crystal deposits. Unlike DECT, it is hard to determine what the deposits are with MRI, and it is almost impossible to detect if they have eaten into bone (unless there is clear bone erosion, but even normal X-ray will show that).
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However, they can be used to show that urate lowering treatment is working. So, you can take a baseline MRI scan, take a few months allopurinol or febuxostat or other gout medications to lower uric acid, then repeat the MRI to assess improvement. It is absolutely vital during the treatment to have monthly checks to ensure uric acid stays below 6mg/dL.
Keith (Gout Admin) said:
Though MRI comes nowhere near DECT for diagnostic purposes, it will show uric acid crystal deposits. Unlike DECT, it is hard to determine what the deposits are with MRI, and it is almost impossible to detect if they have eaten into bone (unless there is clear bone erosion, but even normal X-ray will show that).
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However, they can be used to show that urate lowering treatment is working. So, you can take a baseline MRI scan, take a few months allopurinol or febuxostat or other gout medications to lower uric acid, then repeat the MRI to assess improvement. It is absolutely vital during the treatment to have monthly checks to ensure uric acid stays below 6mg/dL.
Keith, per your own blog:??
?MRI
MRI, though not cheap, is more widely available. It will detect bone erosion earlier then x-ray, and it will detect deposits, though not what they are. The 2009 study concludes that MRI might be most useful in assessing joint problems associated with gout, whilst the later report notes that it is the only technique to show bone marrow swelling [edema].?
What good is a tremendously expensive MRI when it does NOT tell you what deposits you are dealing with??? Besides, if you ever had an MRI you'll know how far away you want to stay from it, if you can help it.
forya,
I have experience with back degeration at L5-S1, L4-L5 (discs are crushed and?long gone)?with myself and far higher up the lumbar spine with friends. I have observed for decades the effects of surgery on others. For myself I decided NO.
My advice is DO NOT HAVE MULTIPLE FUSIONS because the benefit to risk ratio seem to me less than one, a great deal less.
I know a woman who has had over a dozen surgeries beginning in her 20's who is in worse pain in her 50's than when she started.
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A close friend has had multiple fusions 2 years ago and is now dealing with loose pedicles and a life of barbiturates and muscle relaxants?and pain. Once they fill you with stainless steel there's no going back.
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Consider the back pain SEPARATE from gout, whether it is or isn't. Control your uric acid and learn what your back will and will not tolerate. For a bad back there is no magic bullet, only doctors who THINK they can help, while amassing fortunes for themselves.
If you wait 5 years and decide you want back surgery, at least that is enough time to be an informed patient.
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You have the sympathy of a person who has had a ruined back for 35 years and gout for 20.
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NEVER take another thiazide.
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