Keywords; gout, early symptoms of arthritis, chiropractic help, what are phytosterols.
What is it and what are gouty tophi?
This is an extremely painful condition, most usually in the great toe, but it can occur in any joint in the body.
The onset is sudden. You wake up in the morning with a slight pain in the lower limb, and by midday you can barely walk. The pain may be in the big toe only, but usually spreads to the whole foot, and even up the leg.
What causes this nasty condition? Uric acid is a quite normal breakdown product of protein metabolism, particularly red meats and sea foods.
In this painful condition there is a missing enzyme that is vital to the break down and normal excretion of uric acid. The result is that urate crystals form in the joints causing them to become red, swollen, shiny and extremely painful; the whole foot becomes hot.
They can also build up in the kidneys causing stones.
Mushrooms have been implicated as a causative factor, as have diuretics.
The vast majority of people with high uric acid remain asymptomatic and never develop pain. Why? We're not sure, but it is mostly to do with the overall wellbeing of the individual. Eat healthily with plenty of fibre from fresh fruit and salad, drinking plenty of water, exercise regularly and you probably won't get gout, even if you are missing the vital enzymme and have high uric acid.
But prolonged and repeated attacks cause gouty tophi.
Read more about an essential oil from Juniper which can help disperse the uric acid crystals. Essential oil ... especially Juniper. In general, arthritis is about oils, fatty acids in the body. The juniper contains many organic oils with the unlikely names like pinene, camphor and myrcene. Whilst hard research has not (yet) been done on the effects of these unusual oils on the body, juniper oil has been used for centuries for gout and arthritis, swelling in the lower legs, problems with the prostate gland causing urine retention, and many other ailments.
There is strong scientific evidence however of other essential oils, a deficiency of which definitely causes the early symptoms of arthritis and ultimately the disfigurement and disabality of the arthritic conditions. For example, anti inflammatory omega 3 ...
Odd, only the left foot is affected. With peripheral joints like the toe and elbow the sudden onset of gout is usually easily diagnosed.
However, gout can affect any joint. Over the past two years I have been treating a patient, first with very acute right shoulder pain. Then three months later severe sacroiliac joint pain, then severe pain in the lower back pain radiating to the left hip and thigh. In all instances, the presentation was baffling, both to his medical doctor and myself. It wasn't a frozen shoulder, or rotator cuff syndrome, it wasn't the typical sacroiliac joint syndrome that chiropractors treat on a daily basis.
The severe back and hip pain was more typically a chiropractic problem, but there too on reflection, neither was it straight forward.
Now suddenly, the typical presentation: severe pain in the great toe. Underlying all these episodes that lasted only a few days, but in each cause very severe, atypical joint pain, was gout. A build up of uric acid crystals in the joints.
Why this joint, then that, what sometimes right, sometimes left? No one knows.
What provoked these attacks?
Now this is interesting. Being a doctor is fun, like being a detective, looking for unusual patterns, and the unexpected.
This patient was a fairly heavy beer drinker. Two quarts a night, which probably makes him an alcoholic. But to prove to himself, and his family, that he was the master, not the servant, of alcohol, he would periodically give up all booze for a week or two.
Bingo, giving up
beer, coincided with cutting back on two quarts of fluid in his diet.
Giving up what was probably the very cause of his gout, alcohol,
simultaneously caused severe attacks of pain.
No one is quite sure why but, whilst hospitalisations in the USA in the last 20 years have increased by 11%, hospitalisations due to the Big G have mushroomed by nearly 400%. That's nuclear! Avoid mushrooms if you suffer from the Big G! Otherwise eat masses of them!
Common sense can be totally misleading, but it's not unrealistic to assume that it's related to the 'crap' fast food diet that Americans 'enjoy'. Getting back to eating a genuine salad (not a leaf of lettuce and a quarter of tomato) several days a week, plenty of fruit and raw food in general, back to nature is surely what it's about.
It's a very treatable disease but it is doubtful that straight chiropractic has any role to play. In the acute phase it is best treated with NSAIDs and medication to reduce uric acid. As with all inflammatory conditions, icing with an ice cube is the topical treatment of choice. Once the acute phase is over it is best to reduce protein rich foods, especially red meat, which is beneficial anyway. Mushrooms should be avoided. According to Wiki the red wine story is a myth, but beer has a profoundly detrimental effect. Shame!
More salad and, as with all the inflammatory arthritides, fasting may be of value.
Like all diseases, if neglected, it can produce gross changes in the body particularly, in this instance, in the joints.
Of concern is that treatment with a bisphosphonate drug may cause osteonecrosis (bone death) in some joints.
There is much that can be done in the way of natural arthritis relief for the Big G. But you will have to do your homework for good solid dietary suggestions that MAY enable you phase out, or at least minimise your drug intake.
Early signs ...
Most people get early warning signs, and you will have to learn to recognise yours. You are likely to get warnings like this:
DO NOT DELAY
Your first attack will probably pass within a few days. Drink plenty of water, cut out all beer, mushrooms and red meat, and take a few over the counter anti inflammatory drugs, recognising the dangers if you take them for any length time. Max three days.
Exercising the foot to help remove the oedema will be extremely painful. But... if you stand in a cold swimming pool, within a few minutes, you'll be able to move the toes and exercise the foot and ankle too. It's probably not visible on this photograph, but the redness and swelling is progressing up the lower leg. (That's an artifact over the second toe, a bug floating on the water.)
And, if you start to get repeated attacks...
Gout attack kit
A G-attack seems to have a very sharp curve whereby the longer you wait to intervene, the more the related pain/discomfort and therefore the longer it will take to heal. Hit it early!
Take the colchicine for at least 3 to 4 days, and continue the goutex and alkalising salts once a day for at least a week.
If you delay then there's only trouble coming.
In severe cases, or when you have waited too long, an anti inflammatory works wonders to decrease the severity of the pain. If desperate you might also like to use allopurinol or its generic puricos for a few days to help to inhibit uric acid production, but only in patients who have repeated attacks.
Phytosterols and omega 3 are a part of the solution.
Gout is one of the many forms of arthritis so increasing plant foods that contain phytogens and omega 3 makes sense. A tablespoon of freshly ground flax seed sprinkled daily on your cereal contains both large amounts of both lignans and alpha linolenic acid, one of the omega 3 fatty acids.
And what are phytosterols you may well ask.
Did you find this page useful? Then perhaps forward it to a suffering friend. Better still, Tweet or Face Book it.
Interesting challenges of the day
1. Mr D has very severe midback back. He bent and twisted, feeding his son, and then laughed. Every breath is a nightmare. A sprung rib is every chiropractor's delight. He or she has golden hands. 30 percent better after one treatment.
2. Mrs C has a long history of severe, disabling migraine headaches since having her wisdom teeth removed. She clenches her teeth at night. After six treatments she has no migraines but some jaw joint discomfort remains; a bite plate is in the offing.
3. Mrs U has the trophy for the worst back this year. After major surgery with plates and screws two years later she still had paresis in the lower leg and severe disabling back pain. She's doing far better than expected, in no little part due to a lift in her shoe for a very short leg.
4. Mr V is 86 years old and hurt his back helping his wife into the car. Just one treatment of the sacroiliac joint and he's eighty percent better. It's not always like that.
5. Mr W lay on his back knocking down a pillar. Turning his head causes severe vertigo. He needs the Epley exercises, not pills, research shows. Update, he's fine.
6. I myself had an acute exacerbation of a femoral nerve lesion last year. One immediate treatment by my colleague has fixed the pain in the lower back, but there's some residual numbness in the lower leg; no soaring tomorrow alas.
7. This lady is a 86 year old woman with a 63 scoliosis. Chronic lower back has been her lot in life but she's well pleased with chiropractic and comes for chiropractic help once a month; some conditions you can never cure.
8. She is an 78 year old woman, is doing remarkably well with a bad sciatica. But over 200 pounds she is not losing weight; in fact, gaining despite my suggestions. She's high risk for a stroke. I have referred her to a dietician to crack the whip.
9. A 61 year old man with upper cervical pain yesterday; it's not severe but also not getting better of its own accord. He's afraid it may turn very acute as when I treated him three years ago. Since then it's been fine.
10. A 64 year old woman has had scheuermanns disease; it's left her with a spinal kyphosis and chronic middorsal pain. She responds well to chiropractic treatment provides she come every six weeks or so for maintenance treatment.
11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.
12. Mrs D, a middle aged woman with hip pain of one year duration, despite other treatment. Xrays reveal an impingement syndrome and early hip arthritis. There's much to be done.
13. Mrs B has had one of the nastiest of conditions; vertigo caused by a disturbance in the inner ear. Falling repeatedly and vomiting she consulted her doctor but medication didn't help. After two sessions of the Epley manoeuvres she was 50 percent better. After two weeks 75 percent improved. No longer vomiting all falling. She's not enjoying the Brandt Daroff home exercises.
And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.
Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?
Greetings, Dr B.
You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.
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