Microsoft word - drbob-dec09.docx
Health Matters: Don’t Jump
Hit your big toe with a hammer and you will have some idea how gout feels. The funny thing about
gout pain (funny in the same sense as a public beheading) is that it is not caused by an injury, but
by the immune system. “Why”, you ask, “would anyone’s immune system want to create
something like a gout attack?” Well, it is probably a mistake. Let’s look at the biology of gout.
People with gout have too much uric acid. Uric acid is a waste product. It is made when your body
metabolizes DNA from the animals that you eat; cow, turkey, pig, the neighbor’s cat. Your cells are
just slobs and they throw the uric acid into your blood steam and walk away. Eventually it ends up
at the kidneys, which I like to think of as the sewer of the body; it’s the romantic in me. They filter
out the uric acid through structure called the “nephron” (Latin for “stinky sewer tube”). But
sometimes they don’t filter out enough and it accumulates. When too much accumulates, it forms
little crystals inside of joints. For some reason your white blood cells go monkey nuts and attack
these crystals. The result is terrible inflammation and pain. There is also a lot of damage done to
the joint cartilage. Ultimately this leads to arthritis. Skin too can be damaged by uric acid and it
can cause kidney stones, yes, right in the stinky sewer tubes themselves.
One good thing about gout (good in the sense of three public beheadings) is that it is pretty easy
to diagnose. Usually the joint affected is the big toe. It turns bright red, swells, becomes hot, and
hurts really badly. You will not want to move the joint at all. Who gets gout? It tends to be more of
a problem for men, older people, people with high blood pressure, diabetes, over weight people,
and people who consume lots of meat, seafood, fructose corn syrup, and alcohol, and it can also
be triggered by an injury to the joint. A bad plan would be to eat shrimp, beer, shrimp, beer,
shrimp, beer, while kicking the wall, if you are prone to gout, otherwise it is just fine.
In treating gout you basically have three choices. You can change to the perfect diet, take a
medication to reduce the amount of uric acid in your body, or give up and jump from the 30th
floor. I suppose you could combine these choices as well, such as jumping from the 30th floor
while eating a perfect diet. Dietary changes help, but they usually don’t resolve the problem. One
of the best treatments for gout is a medication called allopurinol (coincidentally another Latin
word for “stinky sewer tube”). This medication works by stopping the production of uric acid.
Over time, quite a long time, uric acid levels in the body decrease. When they reach the magic
number of 6, gout attacks dramatically decrease or stop altogether. This is a great day and all of
the slob cells rejoice and then go right back to throwing uric acid into the blood, so it is important
to keep taking the allopurinol. Using allopurinol is tricky, because starting allopurinol can trigger
a gout attack and so can stopping it. That is ironic, or paradoxical, or coincidental . I don’t know,
but the mantra for allopurinol is to keep it steady. To prevent a gout flare up when starting
allopurinol, another medicine is usually used along with it for a while. Gout is treatable. You don’t
have to jump.
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