My Bout with Gout

A 1799 caricature of gout.

One of the perils of Paradise is an insect bite. Here in Vieques we have the usual suspects that are common to the North – mosquitoes, bees and wasps, spiders. But in the tropics we have some big-time chompers – tarantulas, scorpions and the fleet-footed Puerto Rican centipede that can approach a foot in length.

I have adverse reactions to stings and bites. On my fair Ukrainian skin, a mosquito bite welts… a fire ant’s acid attack can blister and itch for a week.

So when the big toe of my right foot began to swell and throb recently, my first thought was insect bite. 

But instead of dissipating after a day or two, the swelling increased and the pain worsened.

Now, my wife’s sister is a registered nurse. My wife believes that the tight DNA connection between siblings gives her as much right to dispense medical advice as her sister.

“Soak your foot in water as hot as you can take, and it will draw out the poison,” my wife ordered as she poured boiling water into the bucket we use to mop floors.

By the second day of this medieval torture (in addition to the painful toe, my entire foot was now scalded), I made an executive decision that this was no insect bite. I couldn’t bend my toe at all, and pressing it down against the floor caused stabbing pain.

“You probably broke your toe,” my wife said, changing her original diagnosis. “I myself once broke a toe by wearing bad sandals.”

It was Sunday, and the thought of seeking medical help the next day plunged me into deep depression.

Like a miracle, however, Monday morning brought improvement in the toe. Yay! It’s not a broken bone. No emergency room!

That evening, we went out to dinner with our neighbors – who both happen to be retired doctors.

In the car, I mentioned my toe trouble – as casual chit-chat, not as a try for free medical advice.

Suddenly the two doctors morphed. They were two kids drawn to my troubled toe as if it were a piece of candy.

Mr. Doctor, a pediatric urology surgeon, said, “Could be gout.”

I laughed. I knew gout to be the “disease of kings" or "rich man's disease."

Mrs. Doctor, an anesthesiologist, agreed with her husband and recommended I spray Benadryl on the toe.

Mr. Doctor challenged his wife: “Really? Do you think topical application would have value?”

So there I was, enjoying a toe consult by two prominent medicos … in the car … on a dark Vieques road.

“I’ll come over in the morning to look at your toe,” Mrs. Doctor offered.

But in the morning, it was her husband who sneaked over to our house and made me show my toe. 

Gout is a recurring ailment, so in an effort to forestall future flare-ups, I turned to the Internet for information. Here’s what I learned.

Gout’s been around forever. Hippocrates in 400 B. C. wrote about it -- noting its absence in eunuchs and premenopausal women.

Gout is acute inflammatory arthritis resulting in a red, tender, swollen joint. The joint at the base of the big toe is affected in half the cases. The elevated level of uric acid in the blood that causes gout is also responsible for kidney stones.

Causes of the condition include the usual caloric culprits: not enough vitamin C, too much meat and seafood, overdoing alcohol and fructose -- and obesity.

In 1683, an English physician posited yet another cause:

“Gouty patients are, generally, either old men, or men who have so worn themselves out in youth as to have brought on premature old age -- of such dissolute habits none being more common than excessive indulgence in venery.”

If you have to look up the definition of venery, you obviously haven’t lived enough.

In my next blog, “Another Similarity”