Thursday, March 19, 2009

Intimate Details

I've spent the past few days with a condition that I find embarrassing. I don't know exactly why, perhaps because I associate it with images of gluttonous, Victorian gentlemen with swollen toes, who have gotten their just desserts, so to speak. In fact, when I Googled "gout cartoons" to illustrate this post, that is exactly what I found. There were some others, but none were funny. There is, of course, nothing funny about gout. The other night as I lie awake in bed imagining a knife with a red hot blade implanted in my foot while gremlins hammered and poked needles into my toe, I thought that amputation at the ankle would come as a relief.

This is my second flare up. The first was just about two years ago. At that time I thought I had a broken toe; it was a weekend, of course, so I went to a walk-in clinic. The doctor's insight included the fact that I had recently become diligent about taking a daily low-dose aspirin. Aspirin can increase the uric acid in the blood which results in painful crystal deposits in certain joints, particularly the big toes. The crystals initiate an ineffective immune response that causes swelling and more pain. The prescription included a medication that instructed me to take one pill every hour until feeling nausea or till a maximum dosage was reached. I was able to take the maximum dosage without any ill effects until the following day when I felt like I was dying. My insides eventually got outside and my abdomen and ribcage hurt for days. The gout had cleared up, however.

This time I stuck to an anti-inflammatory prescription, ice packs and a plethora of internet wisdom. Information on this ailment is the most confusing, contradictory mixtue of nineteenth century science, hocus-pocus, old wives tales and folk remedies. Many of the websites devoted to gout information are thinly disguised fronts for selling a book of secret home remedies. Among them are eating cherries and strawberries, drinking apple cider vinegar "with the mother" and taking baking soda. Testimonials abound. There are no scientific studies confirming or disproving these cures, but the condition will often subside in a few to several days, basically untreated. So "cures" could be a matter of timing and coincidence.

On the other hand the dietary advice to preventing recurrences of gout include gross contradictions. Forbidden on some lists is vinegar, one of the "cures". Basically one should avoid all meat, including poultry and most all fish as they contain the main food chemical culprit, purines. Legumes, another source of protein (and thus of purines) should also be avoided. Many fats and oils are prohibited as well as white flour and sugars. Molasses and maple syrup are no-no's as are strawberries, another one of the folk "cures/preventatives. Most advice encourages increasing fruit and vegetable intake while other lists forbid tomatoes, spinach, asparagus, dried fruits, mushrooms, cauliflower, peas, beans, celery, radishes, soy milk, dairy products, beer, wine, chicken broth, chicken soup, eggs, oatmeal, whole grain cereals, whole wheat or whole grain bread, chocolate, caffeine, carbonated beverages, table salt.

Now note that recommendations for "good", low purine foods include carbonated beverages, coffee, cereals, chocolate, fruits, breads, grains, pasta, rice, olives, cheese, eggs, milk products, sugar, tomatoes, and some types of green vegetables and lots of water.

If one eliminates all the bad foods, including those on the good list, one is left with water, cherries and potatoes. Think of the combinations!

In the weeks leading up to my gout episode I was eating either homemade chicken soup or lentil soup daily, we went out to dinner and ordered fish or hamburgers a few times, had pasta with tomato sauce, had homemade oatmeal cookies made with brown sugar, molasses, and raisins. I was also making and eating homemade yeast breads, macaroni and cheese, and eating yogurt, sour cream, milk, eggs, chocolate, coffee. I also was aware that I was forgetting to drink water, something that I have to remind myself to do. I hadn't had a cherry since that piece of pinapple upside-down cake I had six months ago.

So this suffering was my own fault, that's why I am so embarrassed, I've been a real glutton.

My desire to prevent another gout attack in the future also included an internet education on modern medicine. I can get a prescription that will lower my levels of uric acid permanently, provided I take it daily, forever. The side effects of this miracle drug include a severe reaction that causes the skin to peel off in sheets resulting in eventual death. One that I can only imagine is more painful than gout.

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