Pain: Gout Explained

What's your name, my name is Pain
Where do you live, I live anyplace
Where were you born, in the state of fear
How old are you, nineteen hundred and ninety four years

What's your plan, my plan is pain
When will you leave, I'll never go away
How will you breathe, you'll give me life
How will you see, sitting in the temple right between your eyes

My name is Pain, you belong to me
You're all I wanted, I'm all you'll ever be
From the beginning in a world without end
I am the air, I am Pain

Pain is love, Pain is pure
Pain is sickness, Pain is the cure
Pain is death, Pain is religion
Pain is life, Pain is television

Pain walks, Pain crawls
Pain is peace, Pain is war
Where were you born, in the state of fear
How old are you, nineteen hundred and ninety four years

My name is Pain, you belong to me
You're all I ever wanted, I'm all you'll ever be
From the beginning in a world without end
I am the air, I am Pain

-- Elton John, Made in England (1995)


I had done some Google referencing and reading for I was planning to comment on some recent development. Unfortunately, it is disrupted by a gout attack.

When you are down with it, you are just handling pain and left everything aside. After a good long dip in iced water this morning, my ankle is beginning to move and I decided to end my April Blogging hiatus to explain about gout and its misconception. Its a different turn from my usual socio-politico-econo interest.

Gout, said to be “disease of kings” or rich men disease, is a metabolic arthritic disorder due to under-excretion or over-production of uric acid. It’s basically a body chemical issue and got nothing to do with your bank account.

The uric acid reacts to become monosodium urate salt and its deposited in the cartilage of joints and certain tissue like tendon. Usually it happens at the big toe. In my case, it is usually the ankle, although I’ve had a case at my right wrist. Those salt crystal makes moving excruciating and swelling is just a reaction. Worse cases of gout could have nodes all over the limbs and bodies and in those nodes are crystals of salt. Imagine the pain.

Chemical structure of Uric Acid from Wikipedia

What is gout pain like?

Let me tell ye. Have you had a case of ankle sprain? It’s usually a sharp pain followed by discomfort from perhaps a swollen ankle. Imagine having that pain constantly for a couple of days periodically heighten by bouts of throbbing. There is also the extreme discomfort from the swollen big toe or joint.

I would usually be able to sense the symptoms and do the necessary precautions. By morning, it is usually over. This time around it is unavoidable.

I accidentally slipped and sprained my ankle entering the PUTRA train during a crowded peak hour at the KLCC station two days ago. This is a usual recurring ankle injury from my sporting days. It shouldn’t be so bad if I had got seated. What do you expect in a rush hour? So I was standing all the way and even continued standing in the feeder bus. By the time I reached home, my ankle had already swelled.

For one with gout, any physical stress, fatigue and inflammation at the joint invite the friendly gout attack. It’s like inflaming an area that is susceptible to inflammation. A gout patient with a weight problem is in a vicious cycle of no return; limitation to endure physical excercise and dieting increase uric acid in the blood.

There is no cure for gout.

So you take prevention to avoid frequent attacks and having it advance to more chronic stages through dieting and medical prescription. The mainstay is allopurinol or its popular local brand, zyloric, to help reduce the production of uric acid.

Other than the popular belief to avoid excess consumption of seafood or meat, other food groups do raise the body uric acid level. It is essentially produced when purines are broken down by enzymes in the liver. Purines are complex chemical compound generated by the breakdown of cells in normal cellular turnover or ingested in purine-rich foods.

Complex Chemical Structure of Purine from Wikipedia

Food rich in purine ranges from red meat, organs, seafood, freshwater fish, sardine, and anchovies, to legumes, asparagus, spinach, mushroom, and cauliflower. Practically all food contains purine, so you should know the food with different level of purine. A good habit to acquire is to consume lots of water. It helps to excrete uric acid in the system.

During gout attack, thats important. In addition, I’d stop taking allopurinol for it worsen the attack and switch to colchicine, a granulation inhibitor. To reduce inflammation, one could use a Non-Steroidal Anti Inflamationary Drug or NSAID. My remedy is usually to ice it down. If you can't stand the pain, pop in a pain killer. Colchicine or pain killer have long term effect on your kidney, so do so with care. Finally, lots of rest. What else could one do with the pain and discomfort?

Is there any natural remedy?

I’ve attempted to go natural to replace allopurinol with celery seeds pills and other natural remedy claims. Frankly, it is not that useful. By the time I eventually had my gout attack, it happened too frequent. Gout is a body chemistry problem, so know your bio-chemistry. If anyone can't explain their suggested remedy, just ignore it.

Nevertheless, its a good habit to consume fresh vegetable, fruits and herbs. There are purine-neutralizing and helps to reduce inflamation like berries, cherries, and celery juice. Local misai kucing have been found useful as diuretic to balance bodily fluid with enhance urine excretion. Some doctors recommend distilled water but I doubt it's any better than normal water to dissolve low solubility coeficient organic salt.

Lets be philosophical about gout or any illness we acquired. Its a nice reminder to hold back and take life in moderation.

Pain is love, Pain is pure
Pain is sickness, Pain is the cure
Pain is death, Pain is religion
Pain is life, Pain is television

Thats deep man, deep.

I am the air, I am Pain.

A Voice
Kuala Lumpur
April 6th, 2007 12:00 p.m.