Living with gout





This page about living with gout was last reviewed, or updated, on 13 July 2013.

"I consider even a single fit of gout, however slight, should be looked upon as an intimation that the patient cannot go on with impunity in his then habits of life; it is a warning that either he must change them or expect returns of the disease which as time advances are certain to increase both in frequency and duration, and are likely to embitter and shorten existence."

Sir Alfred Garrod, 19th century gout doctor and pioneer, in his book: "The Nature and Treatment of Gout and Rheumatic Gout."

DEALING WITH GOUT

When considering what living with gout means, the most important fact you should always keep in mind is that gout is a progressive disease, so it gets steadily worse over time. The time between attacks shortens, the length of attacks gets longer, the attacks possibly become more painful, and deposited crystals may develop into a

chalky-like tophus or tophi (plural). Tophi develop, despite the fact that attacks end when MSU crystals get dissolved and, it's thought, the proteins covering them, which have been discarded, re-cover the crystals.

You'll make frequency and intensity worse if you do those things that trigger gout attacks. Tophi can be deposited all over the body, including in and on organs - the kidneys are a special target. An initial attack that clears up in five days, a few years later could be a five week misery. Eventually, it has been known that gout sufferers are in permanent pain. So, to put it bluntly, I'm sorry to say that unless you deal with it, sooner or later, it's going to get worse. This is not something that you can forget about, although some people do.... until their next attack. Whilst gout isn't contagious, once you have had an attack you will have to be on guard against it for the rest of your life.

Being on guard means avoiding mistakes. Common ones include eating the wrong food, drinking too much alcohol, getting your feet cold and wet, or not drinking sufficient water. Visit our gout triggers page to read about others. 

Your first gout attack is a life changing event. Unless yours' is a case of hereditary gout, what has probably and ultimately caused your gout is that you have been eating and drinking the wrong things; or, if you are in your fifties or above, you have suffered from a steadily increasing uric acid level; or you are over-weight; or your kidneys have not excreted uric acid as they are meant to. This means that your diet has to change, and many of your favourite (favorite) foods will have to be discarded. Not a pleasant prospect, but better than a gout attack.

It's also likely that you have not been getting enough exercise, so that has to change too. And in future you must get used to the idea that you will be making regular visits to doctors.

If you are getting the best gout treatment, one regular event (every 2-4 weeks) is that your serum (blood) uric acid level is checked. And you are tested for your uric acid excretion - or at least how much you remove in urine. If medicines are your only way of dealing with gout, you must get into the habit of taking these on time too. Living with gout requires new disciplines in your life, which you ignore at your peril.

MOBILITY MISERY

Gout in the fingers, hands, wrists, elbows, or even the ears' ridges, probably won't affect your mobility, and you may be able to go to work. Unfortunately these body locations are not gout's favourite (favorite) attack targets. It likes the big toes and the feet  most, which makes coping with gout harder. The chances are you will be stuck in bed or in a chair/sofa with your foot on a gout stool, the classic gout pose.

Here are some routines you may not be able to take for granted during a gout attack. Going up or downstairs; visiting the bathroom; cooking, or fixing drinks; maybe showering or having a bath; dressing and changing clothes. You might be able to hobble around on crutches, or on your tip-toes (if not stiffened), but don't bet on it. Some people, taken by surprise, have had to <i> crawl </i> to the bathroom to get their medicine. And so many gout attacks start at night, so keep yours close by your bed.

CAN GOUT BE CURED ?

There is a well founded ambiguity in much writing about gout about whether it can really be cured. You want to hear that you will not have to be living with gout, and coping with gout, for the rest of your life but the problem is that once you have had a gout attack it can return. There is something about this malady that once an attack has happened, it is somehow in the system.  And there is the extraordinary fact that it has even been known to attack artificial joints! Studies of long term avoidance of repeat gout attacks are thin-on-the-ground.

Gout can be beaten  Now for some good living with gout news. Generally, for a majority it can be beaten. By beating gout we mean that you never get a repeat attack and have no tophi.

The best way of summing this up is to take note of what some former gout sufferers who learnt the subject, did it right, and are able to say. "I haven't had a gout attack in three (for example) years, and I used to have them every three months." To beat gout you get your uric acid (UA) level down to the level at which crystals have dissolved and the gout flares have ended. This is about 5.0 - 6.0 mg/dL in men, a bit lower in women. After that, what you need to do for the rest of your life is to keep uric acid at or below this level.

Doctors will probably say that you must take medicines like allopurinol, febuxostat, or probenecid for the rest of your life. These drugs are quite successful but they do not halt gout attacks for everyone, and many can't tolerate them. Being on drug medications for the rest of your life is something most people don't want to hear.

So once you have got UA to the desired level, discuss with your doctor whether you should try to maintain a low uric acid level with dietary measures, vitamins, herbs, or natural gout products such as Flamasil or GoutCleanse. And only go back onto pharmaceuticals if your uric acid level rises again (especially if it gets above 7.0 mg/dL, men, or around 6.5 mg/dL, women).

Although uric acid lowering natural gout remedies, when figures are available, do not lower uric acid (UA) levels as much as do pharmaceuticals, they don't raise uric acid, so focusing on eating these regularly, and taking frequent uric acid measurements is vital. A key factor will be the state of your kidneys, because they excrete around 2/3 of the uric acid you remove. (The remaining 1/3 or so, is dissolved in the intestines by bacteria).

Another approach is taken by those who learn to their great joy that baking soda (bicarbonate of soda) or apple cider vinegar, or cherry juice or some other substance will stave off an impending gout attack, and naturally they become very experienced at noticing the signs that this is going to happen. (Usually twinges in a big toe are the sign that uric acid is crystallising (crystallizing) and the crystals are about to be deposited). So if these gout remedies work, or half-work, they work quickly. For these gout sufferers, living with gout is less of a challenge. They feel confident they can deal with it.

If you find you are able to do this, don't forget to pay attention to your uric acid level, and get it down below your gout-attack free level. One way of improving the chances of not getting a repeat attacks is to use alkaline gout remedies (ionized water, pH drops, alkaline foods and alkaline green food supplements), which like baking soda, also raise blood pH. Whilst baking soda should be used sparingly, these can be used daily. At higher blood pH, uric acid is less likely to crystallise (crystallize).

IT'S A CONFUSING JOURNEY

One of the most difficult things about living with gout is that falling uric acid levels can trigger gout attacks. During gout attacks, whilst the crystals are being formed from uric acid, blood uric acid levels fall. That's understandable. But, when it falls in between gout attacks, and falling uric acid is ultimately necessary for a gout cure, attacks are triggered too. So your gout can appear to be getting worse, when actually it's getting better. This doesn't make living with gout any easier.

Visit our breaking through the pain barrier page.

The febuxostat (Uloric, Adenuric, Feburic) research, - allopurinol was also tested - showed that although uric acid can be reduced below 6.0 mg/dL in many cases in a fortnight, the end of gout attacks takes much longer. In the research it took 24 weeks for around 65% of cases, up to a year in about 94% of cases, and two years in over 95% of cases. These were people who managed to stay on the medication. Read more here.

LEARN ABOUT GOUT - IT WILL PAY DIVIDEND$

The more you know, the more it will help you get the best gout treatment. Your chances of beating gout improve if you know all the options and if you understand the reasons why you do what you have to do. And you'll be involved in more knowledgeable discussions with your doctor. In fact if you're not dealing with a rheumatologist but a GP/PCP, and if you spend an hour a day studying gout, you'll come to learn more about it than your GP/PCP. (He/she after all has to deal with hundreds of medical problems).

The 2010 Gout Attitudes Patients survey of 1,000 U.S. gout sufferers living with gout learnt that 2/3 of these gout patients thought the condition is not taken seriously, but half did not know an excess of uric acid is the fundamental cause of gout in most cases.




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