The Sudden Gout Sprout!
I read twenty or more medical articles suggesting the cause for my pain, none of which I fancied. I’m having a problem with my big toe. It hurts. I mean it hurts, like a burning pain, so bad if I had the nerve to take an ax to it, the pain would be resolved.
It happened this way, at 1:00 am, I woke with pain in my right foot, located in my big toe. Jenny drove me to the local ER, at Mercy Hospital on the way to St. Louis. We arrived at 2:00 am. The weather was foul, thunder, lightning, rain lashing down, and Jenny was pissed because she wanted to bring me earlier in the evening. So goes it.
I hop into the ER, not being able to place my right foot on the ground, grimacing in pain. Jenny cannot follow me in, still under Covid restrictions. There’s hardly a limb on my body isn’t bolted together, but none of those injuries, even my arm pierced through with a spear gun, caused me so much agony.
The woman behind the glass partition wants my information, name address, insurance card, description of pain. I give her the relevant information, “and a description of where the pain is,” she asks.
“Right foot.”
“And a description of the pain.”
“It’s written on my face, ma’am.”
“I can’t put that on your admission form, sir.”
“Really, what can you put on the admission form?”
“Mild, moderate, severe.”
“Let’s try severe,” I said.
“On a scale of 1–10?”
“Really, ma’am. I’m in agony. Where does severe rate 1–10?”
“You want me to put 10?”
“If that’s the worst pain, yes.”
The booking nurse is in the wrong profession. She should be at the door of a St. Louis nightclub. She has sallow, oil skin, and a fine moustache that looks like dirt.
“Here’s your insurance card, sir. Please take a seat in the waiting area,” she tells me.
I hop through the doors, wave to Jenny sitting in the car. The cubicle is very nice. Covid proofed. A woman across the way is breastfeeding. I put my nose into my iPhone, still researching my symptoms. At 2:25 a nurse tells me to come through to triage. “Are you in pain?” He asks.
“Can I ask if you received my admission notes?”
“Not yet, sir.”
“They were written up twenty-five minutes ago,” I said.
“Do you need help getting across the floor?”
“I’ll hop, why not.”
I’m asking myself what nurse wears blackout sunglasses at 2:30 am, a mask under a face shield, and doc martin boots?
My foot has been bitten by a serpent, it is full of poison, and will you cut it off? Is what I want to say. “It’s excruciating pain in my big toe, spreading a little way up the top of my foot,” I explain for the umpteenth time.
I re-explain everything from when it started to whether I’ve had previous bouts of pain in the same place.
“No, this is the first time, and hopefully the last.”
“Okay, I have everything written down, and your blood pressure is a little high. I’ll ask you to go back to your seat and we will call you when the doctor is ready.”
Two hours and twenty minutes later they call for me. The angel of death has me in its embrace. Just take me for fuck’s sake.
I’m laid on a bed, I’m given oxygen. “You don’t look well. Can I get you something for the pain?”
OMG! A friendly human being. “I’ve been taking something for the swelling, Ibuprofen I think.”
“How long have you been in pain?”
“Several hours.”
“Did you explain the degree of pain you were in?”
“I did, a couple of times. Severe, I answered.”
“I’m sorry. Anyone who’s pain level is 10 is immediately seen by a doctor. When did you arrive?”
“2:30 ish.”
“Good heavens. I’m sorry. I’ll get the doctor immediately. If he cannot see you, he will prescribe something to alleviate your distress.”
“Thank you.”
As soon as I’m in the back things change. I feel like I’m being taken care of, that the pain I’m in is not something to dismiss.
Within five minutes the nurse is back. “I’m going to put you on a drip, Mr. Hogg. It will give you some relief. When that’s done someone will come down and take you to x-ray.”
Ten minutes later I’m free from pain.
Comfortable in bed, the doctor arrives five minutes after I’ve had x-rays done.
“Hello, Mr. Hogg. How are you feeling?”
“Much better, thank you. The nurse was amazing.”
“Good. I’m sorry to learn you weren’t brought through immediately.”
“Do you have an idea of the cause?”
“Yes, the problem is gout. Fairly common, very painful. But we have come a long way in treatments,” he told me.
“Gout! Isn’t that Henry V111 stuff? I thought gout was something back in the dark ages.”
“This your first painful flare?”
“Bloody hell, yes. I didn’t know how to put myself to ease the pain.”
“I understand. Painful flares can, and often do, prevail — even when patients are taking medications as prescribed and are following a healthy diet and exercise regimen. Sadly, the prospect of another flare is highly likely. Most occur within a year of the first. You’ll have what you think is a symptom-free period, when joints function normally. Looking at your record, I see you’ve been in pain several hours?”
“Yes.”
“These flare ups can last three to seven days once or twice a year, the next phase every four to six months and lasting one to two weeks. This, indeed, is a frustrating time for patients — particularly, if they are adhering to prescription guidelines. I want to set you on a regimen immediately. I want to see treatment bringing the urate levels under control.”
I was listening but not hearing. All I’m thinking about is that the pain will reoccur.
“But I’m in good shape, Doc. It doesn’t make sense to me.”
“It is a myth that poor diet and lack of exercise contribute to the illness. I’m going to refer you to a rheumatologist. We will complete a plan to reduce your uric acid levels.”
There was a ton of other stuff, none of it particularly positive.
I’m sent home with a list of foods to avoid:
- Beer and grain liquors (like vodka and whiskey)
- Red meat, lamb, and pork.
- Organ meats, such as liver, kidneys, and glandular meats like the thymus or pancreas (you may hear them called sweetbreads)
- Seafood, especially shellfish like shrimp, lobster, mussels, anchovies, and sardines.
Life is over.
Someone, please, pour me a drink!
