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Don't knock your forbears VG- it wasn't their bad eating habits but your mutual genes.
Arthritis in the family is a dead giveaway- and as Gout is of that ilk- the old adage of keeping things moving but NOT ,in Gouts case, over stressed.
If your walking involves more than a few miles a day you will be taking a risk of course- but keeping to a regular daily routine and keeping the walks circular, if at all possible, gives you some 'get out' it the 'tweeks' start.
Try a hiking pole ,too. Collapsed- if you don't need it.
From what you've said previously- I bet you're planning 10+ miles a day though!
I have a 6+ mile walk coming up on Sunday- I want to do it but still wary after my recent attack- but I did a shorter 4m one last week, on the flat, in soft sandals +socks, on a quite hot evening too- without problems. Heavy boots haven't helped in the past btw.
It's all a lottery, but the getting out will be good for your angry soul right now! 😉
Keep to one or two SMALL glasses of wine MAX,no beer/spirits -with food and keep the fluids up- and I reckon you'll squeak through- if you avoid the worst food triggers.
I've finally got round to adding a pic of that last attack on Flikr for reference and some notes if they show up.
I know feet aren't pretty but the info is hopefully useful !
Thanks Tev for posting the image. That looks painful. If I see correctly then you have quiet a few tophis. How long have you had Gout? At what age did it all start for you? How is your treatment going?
Yeah last year when I went on a similar five day holiday I walked from 8am to 8pm everyday
Don't know how many miles though and I did not drink enough water like I should have. Five days later on the way back home I fell severely ill for 2-3 weeks. I had super high fever for 10 days non stop. Fever meds would not do anything. I started seeing things due to the high fever and passed out at home. All I remember was my wife crying and thinking that I was dying Went to ER and after battery of tests the docs said that apparently I had caught a very bad virus. After I finally became normal I had lost 5-6kgs in a space of 2 or so weeks
Would be interesting to see my blood uric acid readings from my ER visit. Maybe I should contact the hospital to get hold of it. I am not buying the virus thing though. Anyway as far as I know that incident had nothing to do with Gout.This time I won't walk that long. I will take lot of breaks and drink plenty of water. Hey Trev I meant water not beer and wine
Yes, It's quite strange when you look at what your own body has done with itself!
I suppose it was about 5 years ago [my early 60's] whenthe first twinges started, and it was a while before I got an attack proper. Always brought on by beer drinking- naturally enough.
I love real ale- a prerequisite for suffering in the Gout game 🙂
Yeah, I knew you meant water- but on holiday you need a few naughties so I was giving tacit permission- especially now you corrected me and you're nothing like as Baaad as presumed 😉
I sincerely hope you have a better run this time anyway- enough frights already!
Oh trev, that looks like a doozy. I'll bet you cannot even stand on that left foot.
My bad one was a little less swelling over the foot but a much deeper purple/magenta in the swelling over the bunion joint. I couldn't touch it even with a sock.
(You got a bit of nail fungus going on too…Lamisil works wonders.)
When life gets tedious – it's good to look at an old Gout pic- very nice not to have one going on!
The nail is an old injury which walking boots tends to kick in and maker the nail come off.
Thanks for your concern. I don't think there is any infection.
My foot is almost back to normal now- going on a 6 miler today- so if the boots play up ( can't get away with sandals with recent rain)- I'll chop the distance.
Onwards and sideways 🙂
The nail got stamped on years ago in a scrap.
It sometimes gets stressed on a walk (right where the boots bend) when the nail discolours at the quick a bit and then it comes off!.The new nail will look & be OK for a while then it will probably happen again. Not sure what the weakness is, I just think wherever the nail grows from is vulnerable in some way.The nail still carries striations on the outer side from being crushed- as it has trouble forming well, but otherwise is no real problem.
Makes a change from Gout!
zip2play leave his nail alone
Ok so I got appointment letter from hospital's Rheumatology department today. Appointment is in one month time
Atleast it is one hour appointment so I will be well prepared with all my blood uric acid readings and detailed case info. I hope I get a decent doc and not some clueless pen pusher moron.Hmm just did a search on the doc who wil be seeing me, looks like a young doc in his early 30s. Not sure if that is a good or a bad thing.
Docs? I doubt you will have a penpusher- they have to be a bit more engaged that that in a hospital setting.
If he's really young he will have an 'old fox' lurking behind and will disapear that way if the going gets tough- At least he will be fresh on training but as Gout is still recovering from Henry VIIIs' bad image- that isn't saying much
My last visit to a hospital consultant drew the comment that treatment (for High BP) was a bit hit and miss- & I appreciated his honesty. I would say Gout is a better bet for a result on that score.
I was only there because another [and younger, non GP] Dr. liistened to me and booked me in for serious tests- it didn't go down well with the lead man!
Taking an interest in your condition is a good thing, there is occasional arrogance in the medical profession and not quite enough compassion or humility – though I don't envy their position between the Gov't and Pharma. The pay must help a bit!
Ok so I went on holiday and hiked and hiked and hiked and hiked for hours and hours on end….6-8 hours a day for almost a week.
For last 3+ months my pain is constant 24 hours a day at level 4-5 (out of maximum possible pain level of 10) and my blood uric acid reading is always between 7 to 9mg/dL (excluding higher post exercise readings) . During the hiking trip my pain level stayed at level 4-5 and did not go up higher like I was expecting.
Every second of the day this thing is on my mind and it's driving me crazy!!!! I still have almost a month to wait before my appointment day to see the specialist at the hospital arrives. Why is my pain not going to level 10 like typical Gout patients? I rather have few days of level 10 pain than this constant low level pain chipping away at my sanity
Just needed to shout and get that out of my head
I really don't know what is happening with me!!!!If you blow a few beers, that should do the trick- then you'll be sorry just like the rest of us VG!
follow with a prawn curry, of course!
-but great you got the walks exercise in successfully…
A long wait for a painful condition- any chance you can do a private Rhuematologist, as GP recommends?
In the meantime, stick to sandals with soft foamy velcro straps that can be let out a lot, with thick socks -and never mind the odd stares. [OK- if it rains you need some backup]
I go on group walks where substandard footwear is ignored totally
At least it's summer, sort of.
+Black Bean Broth !
Don't dismiss what I said about hypervigilence. With an acute gout flare you CANNOT walk for 5-6 MINUTES…even with a pot of gold at the end of your walk. With chronic gout5-6 hours walkint is IMPOSSIBLE.
(Don't confuse blood urea with serum uric acid they are VERY different. Do you mean uric acid? Normal blood urea is 7-21 mg/dL…a 21 uric acid would have you looking like Lot's WIFE…frozen in place totally crystallized!)
AND you are a vegetarian…
I mean feet are feet…walking 6-8 hours per day for a week would have GOD screaming in pain…and he hates sweetbreads.
I edited my post zip2play, sorry I meant blood uric acid reading is always between 7to9mg/dL. Yes I am a vegetarian but my dad has Gout so that could easily cancel my good veg diet benefits no?
Yes I agree that with acute Gout I would be in severe pain and definitely not able to hike like I did. My non professional theory is that my excellent diet might be helping me not to cross into acute Gout land….YET. I feel the dam will eventually burst though.
Ok here are the facts once again, might as well recap as I have to explain it to the specialist next month-
F1- Last 4 months I have constant unexplained pain in my left toe with occasional 5-10% swelling. Swelling not always there though but low to mid level pain has been there for the entire 4 month period. No pause.
F2- Blood uric acid readings always between 7-9mg/dL. These include readings taken at my GP's place and using my home test kit.
F3- I feel strange sensation in my right toe too but no direct pain like the in the left toe yet. The general sensation is similar though.
F4- GP's initial diagnosis was that I have just over stretched my joint without me knowing how. X-ray of left toe shows no bone break or any bone erosion. My knee X-rays for somethimg unrelated also shows perfect bones with no wear or tear.
Three months on GP does not know why the pain does not go away and has refered me to hospital Rheumatologist.
GP now thinks that it's possible that maybe I have crystal forming which is causing the pain.
F5- I visited a Rheumatologist privately before and he said that in his opinion I don't have acute Gout. He does not exactly know why I have pain and that I should continue exercising etc as normal but just not bend the toe
The best he said he could do is give me second appointment to come back in September and test my blood uric acid levels. I cancelled that appointment as I have appointment next month with specialist at the hospital.F6- Yes I am vegetarian, extremelly fit and have had a very good diet for almost 10 years now. I have not touched meat, sea food, oily stuff, soft drinks, sweets etc for many many years. My dad has Gout though.
F7- I have full range of motion in my toes. The pain feels deep inside the toe joint and not on the surface. I can rub the toe surface without any oohh! arghh! type of pain.
F8- I am lost!
Some questions-
Q1- Is there “Acute Gout” and then just plain “Gout”?
Q2- Early stage of of uric acid crystals build up in the joints = Gout or only a full blown attack is classified as Gout/Acute Gout?
Q3- Zip2play has confused me a bit now. Is there “Blood urea” and “Blood uric acid”? What is the exact difference and what is the normal range for both? What is their connection with each other? Where does urine ph levels fit in?
I am just gonna throw this out there….
My wife had foot surgery recently to remove a cyst inside her big toe (and do a bunionectomy at the same time). It was growing between joints causing a lot of pressure (and pain!) that helped form the bunion. The cyst never showed up on x-rays but was found using a combination of MRI and pulling crap out with a needle and testing it for that specifically.
I am no expert…but for the vast majority of people, gout comes and goes. You sound like it never goes away. Just because someone's uric readings are always elevated doesnt automatically mean that they have gout. Your father having gout makes you more likely to be susceptible if you let your diet go to hell and you got fat – but that doesnt mean you have gout now.
Feel free to call me wrong – but if it was me, I wouldnt stop looking for answers outside the gout arena. Cysts, pinched blood vessels, pinched minor nerve, toe dislocation improperly reset, scar tissue from an old injury, torn ligament and other things all could cause constant pain in a toe and not show up on an x-ray.
Do you have flat feet? Do you have circulation problems in your feet (numbness, hot/cold issues, etc)? In other words, do you have any other issues with your foot/feet we don't know about?
Just trying to provide food for thought. Sometimes a discarded dianosis will turn out to be right all along.
One last thing…personally, when I have a gout attack it hurts when I touch it. I pretty much do my best to make sure I dont bump it in any way. Even putting on a sock is dreadful. The slightest movement causes pain.
Tavery thanks for the post. Yes it very well might not be Gout related in the end as some things just don't match in severity to typical Gout pain. I have spent nights Google searching toe pain related pages and forums. Nothing matches 100%. Hospital hopefully will get to the bottom of it as they have everything under one roof, so tests hopefully will lead to proper diagnosis. They have to as I am going nuts! Every foot step I take reminds me of the mid level pain….difficult to get on with things without thinking about it.
Yes I have always had cold feet ever since I was a kid. I do feel needle type of sensation since this pain started and as if a lump of hot charcoal is deep inside my joint. It's not hot physically though. Flat feet I don't have.
We shall see next month. I just need to talk with someone hence my posts. I don't want to speak about it again and again with my wife as she is already very worried.
veggie,
Since the beginning of time people have suffered BUNIONS. They are painful and progressive and are often thought to be a curse of shoe wearing becasue most shoeless people avoid them. It is a diversion from the big toes natural forward nfacing angle to an inward facing one. Do a web search, you'll find a million bunion pictures…the cure is surgery if the pain gets brutal. You can imagine that women squeezed into a pointy pair of pointy Manholos suffer them more than men…little known but these shoes were invented by the SPanish Inquisition.
Now think about a long run or hike…with every footfall, the big toe is pushed inwards.
Does your painful toe bend inwards more than the unpainful one.
Does it feel better if you spend a great deal of time barefooted?
Has any doctor said the word BUNION? Try going several days barefooted or with flops.
Does COLCHICINE make the pain stop quickly?
(To show that I really believe what I am saying, I am the only person in my gym to work the elliptical trainer barefooted…I get funny looks but eventually I will see ANOTHER who thinks tthe same.)
Alas, NOBODY except characters from James Fenmore Cooper can hike barefoooted.
Urea and uric acid…not much relationship. Urea is extremely soluble and represents the final animal breakdown product of nitrogen compounds (I guess mostly proteins.) It becomes of interest as a marker for kidney function…failing kidneys remove less and less and hence, uremic poisoning and death or dialysis.
It has nothing to do with gout or joint pain.
Veggie,
Any chance you could post a good picture of your feet from the top and side? It might help us to see what you see.
Sorry for the delay in writting back. Just 5 more days to my hospital appointment
Yes Travery I will post some new photos later today.
Zip2Play-
Does your painful toe bend inwards more than the unpainful one.
Nope. Both look exactly same.
Does it feel better if you spend a great deal of time barefooted?
Not hugely different. My pain is kind of constant with +- 10% fluctuation.
Does COLCHICINE make the pain stop quickly?
Haven't taken any medication so far (apart from creams/balms etc which do nada)
Also my feet are smooth and soft. No peeling of skin….no hardened skin anywhere. Apart from the 5-10% swelling in the toe region. Not very obvious swelling though.
Another interesting thing, for last few weeks my blood uric acid reading is in the 10-11mg/dl level constantly (using home test kit). All readings taken first thing in the morning on empty stomach.
Normally they used to fluctuae between 7 and 9. Now last 5 readings have been between 10 and 11. Unless it is because of exercise the previous day.
It's baffling that for last 4 months I have constant mid level pain 24/7 . No super painful attacks like typical Gout sufferers. I can touch the toe easily and rub it without wincing in pain or anything like that. X-ray shows no problems with the bones. Damaged tendon maybe??? I would know if I had hurtthem though!
I am still thinking that Gout is the most likely cause. Once in a while I feel slight twinge in the right toe as well.
Veg,
Its sounds like you have a similar situation to mine (read my post “lingering symptoms)…I had 5+ weeks with lingering paiin (although initially I had a severe attack for a couple days). I finally got a Rx of Colchicine last week and that seemed to really help. My pain is now down from a 6 to about a 2…and hopefully fading in the near future. Like Zip said in my thread. “If Colchicine doesn't work, then there's a good chance it AINT gout!”
Ok here are some latest photos. The photo with both feet together is with light coming from top right hand corner, so make allowance for extra shadow on the left foot. Sorry about the image quality on the first one.
cjeezy said:
Veg,
Its sounds like you have a similar situation to mine (read my post “lingering symptoms)…I had 5+ weeks with lingering paiin (although initially I had a severe attack for a couple days). I finally got a Rx of Colchicine last week and that seemed to really help. My pain is now down from a 6 to about a 2…and hopefully fading in the near future. Like Zip said in my thread. “If Colchicine doesn't work, then there's a good chance it AINT gout!”
Yeah but I never had a severe attack
Do you mean that even touching it or rubbing it gently would hurt? I have always been able to rub and pinch without serious pain. If I press hard at some points then it is painful like a stabbing pain. Rest of the time I have a hot burning type of pain deep inside the joint. With some random pin and needles sensation thrown in. Actually it is hard to describe what I feel I really hope things will be clearer next week as I can't take this mental torture anymore!
I don't think everyone gets a severe attack all the time…but I'm no Dr. At this point I would try Colchicine. What do you have to lose?
cjeezy said:
I don't think everyone gets a severe attack all the time…but I'm no Dr. At this point I would try Colchicine. What do you have to lose?
I would try it if I could . Is it not a prescription only drug?
I am seeing hospital doc in few days so I will have to wait.Took another home blood uric acid reading this morning and it is 10.2mg/dl again. That is almost 11 straight days at over 10mg/dl level. Everythign is pointing towards Gout I feel! If it is gout then I wonder how much more damage has been done due not receiving proper treatment for last 4 months!
I am feeling sorry for my body! I wonder what is going inside. If I have already problems in my 30s I wonder what other disease I will get later on in my life! Welcome to reality of human condition!
Veg guy,
Your uric acid is TERRIBLE…so that says gout.
But it's not the typical affected joint which is the SECOND joint from the end of the big toe, the bunion joint that is attacked…so that says NOT gout.
To my eye, it looks most like you got a splinter or someting into the juncture of the toenail and the outer edge of your toe. It is indeed infected but it doesn't look gouty to me. Admittedly it's a hard call from the picture.
In any case you must do something about that hyperuricemia. Since you are a vegetarian, and thus not eating too many purines, if I were you I would have a pee test for 24 hours to determine how much uric acid you excrete. If very little then probenecid might be a good drug for you.
(Okay, who screwed up the HTML coding to make this thread two monitors wide?
Perhaps the big pictures…a natural mistake.)zip2play said:
To my eye, it looks most like you got a splinter or someting into the juncture of the toenail and the outer edge of your toe. It is indeed infected but it doesn't look gouty to me. Admittedly it's a hard call from the picture.
No the nail area has nothign to do with my pain. Here is an older photo that I had posted. It shows where the pain is. See the black dot? It's that joint that pains.
This doesn't quite ring the gout bell for me, VG!
With all that walking when it was worse -that would surely trigger an attack at 10+ SUA .
One thought, If it IS gout- then it may be that your immune system is not reacting as it should.
This is a part blessing- have you ever taken Immune boosting supplements like Vit C, E or Zinc?
If so, has it affected your foot pain? It does take time for the supplements to get your immune reaction levels up though and as you keep fit ,just a long shot.
Also, if your colds last a long time -or you get re-current infections?
trev said:
This doesn't quite ring the gout bell for me, VG!
With all that walking when it was worse -that would surely trigger an attack at 10+ SUA .
One thought, If it IS gout- then it may be that your immune system is not reacting as it should.
This is a part blessing- have you ever taken Immune boosting supplements like Vit C, E or Zinc?
If so, has it affected your foot pain? It does take time for the supplements to get your immune reaction levels up though and as you keep fit ,just a long shot.
Also, if your colds last a long time -or you get re-current infections?
Trev I take Berocca sometimes….once a week maybe but not regularly- http://www.berocca.co.uk/vitam…..nerals.htm
No it makes no difference to my foot pain. The foot pain is virtually constant 6 out of 10 (with +-10% variation)
No I don't have any infections and probably had my last cold 1 year ago. Both my feet feel a burning sensation but I wonder if that is more to do with current heat wave.
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