Living With The Gout

(And how the American medical system failed me)

4 am. July 5th. I sat alone, tired, and in excruciating pain under the bright emergency room lights at Providence Medical Center.

I don't mean alone like, no one came with me. I mean I was the only human in the waiting area of the emergency room. Weird, given that these were the wee hours following a long night of young children playing with illegal explosives and residential neighborhoods sounding like the streets of Kabul.

If there had been just one severed extremity or any searing flesh in line before me, I might just have hobbled back outside, pointed a roman candle straight into my own eye, and prayed for a distraction from the pain in my foot.

I was ankle-deep in throes of a gout attack.

If you don't know what the gout is, or you think it's the same thing as gangrene or hand, foot and mouth disease, then let me quickly clarify.

Gout is an acute form of arthritis that typically affects the big toe, though it can show up in any joint. I get it in the ankles, too. It feels like getting your foot caught in a bear trap. If it was on fire. And you had to give birth, while getting kicked in the nuts. And shot. In the face.

When people talk about this horrid affliction, it's never just "gout." It's always, "the gout." Like "The Hague." Or "The Fonz." Why the superfluous "the?" Because pain of this magnitude just demands that kind of respect.

It's also known as the "rich man's disease," which is either because of the rich foods rich people eat, or because it only affect 1% of the population (mostly male).

Ironically, I spent much of my childhood fearing that I would suffer through the unimaginable pain of a kidney stone - a close cousin of the gout in that they both result from high uric acid levels. Those dreaded little calcium deposits were things of lore in my family, passed down from (and through) my father and grandfather before me. The mere thought of having to pee stones out my...well, my legs are tightly crossed as I sit here typing.

But I digress. Back to that big, lonely emergency room. This was my saving grace. Maybe this would be quick. Get in, shoot me up with some pain meds, and get out.

Nope. I waited two hours, writhing in pain every minute of it. When the doctor finally did show up, he hurried me through a diagnosis (sore ankle) and a suggested treatment (anti-inflammatory), and handed me a prescription. Oh, and he gave me two Percoset to get me through the current attack.

Before I could limp out of the hospital, the front desk stopped me for my copay on the visit - $125.00. ONE FUCKING HUNDRED AND TWENTY FUCKING FIVE FUCKING DOLLARS. My copay! Presumably, the insurance company would owe the hospital more on top of that.

Two-hours and $125.00 later, and all I got was a band-aid to a problem the doctor didn't even suggest fixing. Yes folks. This is your American medical system (if you have insurance).

I've been plagued by the gout for about eight years now, the first three of which went improperly diagnosed.

The first time I had an attack, I woke up feeling like I'd sprained my ankle. My primary care physician told me I had a blood clot.

The next time it came up, an orthopedic surgeon thought I might have misshapen bones in my feet, but he wanted to inject me with dye to find out for sure. Dye! The opposite of "live."

What the fuck is wrong with these people?

Finally, my wife convinced me during an attack on my big toe to see a Chinese acupuncturist who spoke no English - Dr. Chan. Limping through the sketchiest part of Seattle's Chinatown, I wasn't sure if I was gonna get rolled, or offered a hit off the communal crack pipe. Instead, I left the oddly sterile offices still in pain, but with a used, brown, paper bag full of roots to boil and soak my foot into. Needless to say, I was not super convinced.

Yet, despite all that skepticism, this was my first "gout" diagnosis (Dr. Chan had a translator).

It was like the veil had been lifted. The great wizard, with the fancy prefix on his name that only doctors get, is really just one of your father's drunk fraternity brothers with a nice car.

Still, I wasn't ready to give up on western medicine. Not after all the wonderful vaccines and inflated insurance premiums they've given me all these years. Not because one wise, old medicine man proposed an ailment that sounded a lot like what I might have.

I went back to the "traditional" doctors to get some second and third opinions. And what do you know? I had the gout. Well, at least as far as they could tell. The only true diagnosis for gout, according to Quincy, was to take a fluid sample from my affected joints during the height of an attack. Translation: They have to stick a needle in my toe and pull stuff out when the pain is at its most unbearable.

Here's the crazy part. Every one these traditional doctors wants me to take a pill everyday for the rest of my life to prevent any more attacks from coming. The rheumatologists, the orthopods, the podiatrist, the family doctor - all of them. The boilerplate line has been, "if you don't want to take the pills, don't complain about the pain."

The pills in question, are called Allopurinol. And it's true. The pills do help reduce the production of uric acid in your system (my grandfather also suffered from gout and was on Allopurinol most of his life - he also died of a heart attack after beating Hotchkins Lymphoma).

Now I'm no doctor, but the notion that a 38-year-old, otherwise healthy man needs to take a chemically engineered substance for the next 50 or so years was kind of preposterous to me. I might rid myself of the gout but at what cost? A golf ball sized tumor on my liver?

So, despite the pain, which was coming more frequently and with greater force, I began searching for an alternative cure.

As wise as old Dr. Chan was, he admitted that acupuncture doesn't always help the gout. And in my case, he was right. What I did learn from him though is that gout is highly affected by diet. No organ meats, shellfish or heavy creams. Done. Oh, and no alcohol.

Now I'm not a big drinker anyway, but they can't mean "no," right? Less, maybe. But "no?"

Actually, "no" really does mean "no." A few sips of beer, and I feel it. That goes for wine and whisky, too. The only social lubricant I've found gout will allow is small amount of the clear stuff - gin and vodka. So that's fun.

Then I started looking into the natural treatments. Black cherry extract is probably the most well-known, though the traditional doctors claim to know nothing about it. Unfortunately, it's an incredibly expensive habit to keep up, and I seemed to grow immune to the sweet little capsules.

I made it through the last winter with a mild amount of pain and was pleased with that. But as the weather warmed, I noticed the inflammation building again like a hemorrhoid on the backside of Mount Vesuvius.

Then I discovered "the Mother." Part of the miracle treatment known as Bragg Organic Apple Cider Vinnegar. I found it online as a natural prevention for the gout, among other things. But it has to have "the Mother."

The more I asked people what they knew about Bragg, the more I found out that it was being touted as the natural cure-all (much like the Dr. Bronner's, complete with quasi-religious text on the label).

It's cheap. Easy to find. And while a little unpleasant to the taste, it has no harmful side effects, other than possibly removing the enamel from your teeth. Fuck it. I was in.

I took two, one-tablespoon doses daily, cut with a little distilled water, and after one week, I was already feeling the effects. Not only was I not having any attacks, all the tenderness in my big toes had vanished completely. This was the best my feet had felt in five years.

And just to be sure this wasn't some weird placebo effect, I held off on buying another bottle after I drained the first one. Within three days, my toes started hurting again. I was back suckling at the restorative teet of the Mother.

So you may be wondering (if you've made it this far), if this stuff works so well, what was I doing in the hospital early Monday morning?

Well, it was fourth of July weekend. And while I've never been capable of a true bender, I did let the beer flow a bit more freely than usual. I had gotten drunk on my feet's new freedom and I paid the price.

What then is the point of this absurdly long post? I've really proved nothing. I hate the western medical community and yet, I found myself begging them for mercy just a couple days ago. I love the Mother and all of it's healing benefits, but I still can't knock back a couple of cold ones without a reaction. What's a guy with the gout supposed to do?

My plan: Make all my cocktails with two parts apple cider vinegar and let Dr. Chan handle everything from the rectal exams up.