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Memorial day weekend 2009 – Day 1-4 of injury and beginning of Gout:
Day 1 – As I walk fast, I accidentally had a very hard direct hit of my right toe with the bed post in the morning hours. Got blood on the injured toe and under the nail and huge pain, but did not worry much. The day went without any incident.
Day 2 -Next day, minor pain but I was able to walk without any problem, did go out and enjoyed the weekend. I had wine and turkey sandwich, and a sweet wine before I went to sleep( first time in my life a sweet wine, I generally take very less wine, 1-2 small glasses not more than twice a week, hence low alcohol taker).
Day 3 – The next day ( after 2nd night of the injury), there was much more pain and some swelling, So I took Advil 400 mg and walked around, limping but no worries. Also took sweet wine, close to 90ml.
Day 4 – The day after 3rd night, I found my right toe was swollen and lot of pain. Walking was very painful, So I went to hospital in the Minor Injury centre. They took X-Rays and I was told that there was no fracture but possible Bursitis and tenderness. They also told me that I have got Gout( I told them that I had a flare of Gout 10 years back, when I was in Wisconsin at -25deg F, too low a temperature for me. My foot had stayed in snow a lot in the snow storms and I was told it had triggered the Gout. There has never been any other flare after that).
I was prescribed Indomethacin SR 75 mg twice a day ( though the medicine information clearly said SR is not to be used for Gout).
Now story after the first 4 days of injury:
Week 1: Continued on Indomethacin for 7 days, not much visible improvement. I then showed it to the my GP.
Week 2-3: I was prescribed Colchcine 0.6 mg twice a day and Indomethacin to continue. The pain subsided and swelling improved within 2 days of Colchicine. After 6 days, I was told to stop the medication. I still had difficult and painful walking, not able to wear shoe. As the luck would have it, after couple of days of stopping the medication, the swelling and pain increased again…the agony was back, though it was less painful than first incidence.
Week 4-5: I was told to take Mortin 800 mg three times a day as GP was not available for a week. The pain reduced but no where near to recovery. I was given Colchicine again after a week, same 2 tabs a day. The swelling reduced within 2 days of Colchcine and foot starting to show better. I was told to reduce Colchcine to 1 tab and Mortin also one tab. I was still not able to walk properly, not able to wear shoes and limped. Got confined to home mostly, and before I can reduce the Mortin dose, I suddenly got high BP -170/110. I went to emergency room and they said –welcome to prescription Mortin club of high BP…and started with BP medication.
Week 6-7: Week 6 was Mortin 800 mg a tab and Colchicine a tab. Week 7, Mortin withdrawn and only Colchcine 1 tab continued. I started walking a bit, limping, only wearing Birkenstock sandles, no shoes at all.
Week 8: No medication, doctor told me that my gout is gone and only after effects of the injury are left, which would take 2-3 months before my pain goes away fully.
Week 9: The pain came back, little bit burning in the joint and swelling. Doctor told me to start Mortin 800 mg 3 times again and do detailed blood tests. I also started Colchcine 2 tabs a day at my own. I did not take much Mortin, just 4 days, 400 to 600 mg 2 times a day. There was not much pain and the foot started improving again with Colchicine. The blood test showed Uric acid 9.2, normal kidney and lever tests, high cholesterol as I was not taking Vytorin for 2 months now.
I showed the foot to Podiatrist who did X-rays. The X-Rays showed a minor hair line fracture on the lower side of foot just below the big toe. The fracture was calcified, meaning nearly healed. I was told that the Gout attacks and pains were recurring because the joint swelling was not getting treated and that was becoming a ground for crystals to deposit. So, it was fracture, ligament tearing and Gout, 3 things going on at the same time.
Week 10 – I was given Post Operative shoes to support my toe and started with 300 mg Allopurinol and Colchicine 2 tabs a day. The 300 mg made me feel really sick so I reduced the dose to 150 mg from second day. The foot got better, but I did get lethargy, dizziness( BP medication) and uneasiness on days.
The Uric acid test showed value of 7.0 after one week of medication
Week 11: Post operative shoes / Birkenstock made me walk around, also started driving the car after 10 weeks, Allopurinol 150mg and Colchcine 1 tab a day with BP medication continued. The BP medication dosage reduced to half as I was getting lot of dizziness. It seemed to work with less dizziness.
Week 12: I am told that my Gout is now fully treated. To improve the movement of the toe, physiotherapy has started, twice a day. I am given special orthopedic shoes. I am able to walk now but still have limping, which I am told will go away after sometime.
The uric acid test shows value of 6.6 after 3 weeks of Allopurinol 150 mg
Week 13 – at present: Allopurinol increased to 200 mg in last 2 days( I increased it by 50mg after 3-4 weeks), Colchicine 1 tab and BP medication once a day and physiotherapy twice a day. My foot is moving better, the toe movement has improved, limping is reduced, and I have started going out after 3 months and driving my car.
The foot is not fully free yet and I do get pains in the foot and toe but I am told that this is natural recovery process and as the toe has not moved much in 3 months, it will take some time and the pains would go away.
Let’s see how the coming days go. I will get the labs done next week and see where my numbers stand. I am not sure it is Gout, Injury, both???
I am still not comfortable with the foot, it is still agonizing and I am not able to walk freely. Limping is still visible though reduced a lot.
ONE IMPORTANT THING IS THAT DURING THE RECURRING ATTACKS, I GOT PAIN DURING FIRST ATTACK ONLY. IN ALL OTHER ATTACKS, THE SWELLING WAS THERE BUT THE PAIN WAS ONLY WHEN WALKING, THERE WAS NO PAIN WHEN THE FOOT WAS RESTING. THAT CONFUSES ME MORE AS GOUT PEOPLE GENERALLY HAVE VERY PAINFUL CONDITION EVEN WHEN RESTING.
Few more things to add:
1. My pain during walking has been mostly on the balls under the big toe joint and on the top side of the toe where it bends.
2. The big toe joint still feels pressure when I put my foot down(Load it)
3. When I walk, first few steps, it pains on the lower side of the joint but then after few steps, it becomes better
4. I feel twings in the foot near the big toe area, joint and the balls under the toe.
In summary, not a happy situation yet though much improved. I am puzzled if it is due to injury ( which understandably takes time to recover) or just prolonged gout, which is taking its own time and adding to the agony.
I have no visible tophy anywhere in the body or in the X-rays. The X-rays do not show any bone erosion yet, except for one very small edge(negligible marks). I have no pain in any other joint.
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