If you follow the previous link to my favorite place on the Intertoobs (Wikipedia) you'll probably see a picture of a demon-looking thing viciously attacking someone's right toe. This almost comes close to describing what it's like, though nothing really does. I get awful migraines, have torn muscles, dislocated shoulders, and generally abused my body in ways that the vast majority of modern white collar workers don't. NOTHING comes close to the pain of gout. When you have a normal injury, you can usually find a position where there isn't much pain. When you have a gout attack, it seems like nothing will ease it. If you're lucky (?) and get it in one foot, you can almost function. Apparently some folks get it in their hands which I would super struggle with. You may hear that "even the weight of bedsheets is painful". I can attest that this is true.
I've now had two attacks. The first was in the winter of 2006 during a holiday break. It started with stiffness in my right big toe in the early afternoon during a drinking binge (I did that a lot at that point) and lit up like the sun by the evening. The next day I went to a doctor and had drugs before I got home. In a few days it was cleared up. I largely stopped thinking about it until the next attack late in January this year. This time I didn't go to a doctor, mostly out of inborn stubbornness, and suffered for the next four weeks. We aren't going to talk about why but we are going to talk about what.
The Intertoobs in 2006 weren't what they are today. I did some research but didn't really pay too much attention otherwise and the supposed "helpful dietary restrictions" were often contradictory. This time around and after about a week and a half of agony, I did more than a cursory reading of whatever material I could find as I became more desperate for relief. Most of this largely didn't help and was still contradictory, often parroting exactly the same words that every other site did.
I didn't do any actual science but here were my observations colored by acute and persistent pain:
- Elevating my foot helped quite a lot. I elevated in the evenings so I could sleep at all but getting that foot on the floor to, I dunno, use the toilet came with tremendous pain.
- There was a shit-ton of swelling during the entire time, probably due to increasing levels of damage as the attack wore on. I'm almost convinced that a lot of the pain this time around was a result of the additional damage due to hobbling (badly) on it while in a super swollen state. That toe is still stiff a couple months later which corroborates the thought that there's been long-term joint damage.
- Soda (Diet Coke in my case) made it worse, especially in the evenings. Once I realized this, I stopped drinking soda entirely for three weeks.
- Alcohol of any form also made it worse, usually a lot worse. This one I probably should have known but didn't. Once I figured it out, I got a sober month out of it.
- There was a definite roller-coaster of pain. Getting out of bed and downstairs was usually the worst. Later mornings to early evenings were fine but it ramped up a lot after that.
- This seems to be due to a correlation between eating and the severity of pain. I didn't eat for a day to test this and it seemed to hold true. I'd been in the habit of eating a heavy meal in the evenings, usually with soda, which always meant that by 8PM or so I was again in terrible pain.
- Carbs seemed to make this worse over non-carbs as well as large meals over small ones.
- I cut meals to two light ones a day mostly consisting of cheese and/or eggs which didn't seem to cause issues. I would have probably eaten more meat if it wasn't such a struggle to get to the store. Quiche, store-bought pie crusts notwithstanding, seemed to be the answer.
These remedies didn't work or did with drawbacks:
- Vinegar pills seem like they should have worked for reasons that will be clear below, but didn't. They also taste terrible. I got no particular relief from taking them for a few days.
- This was also shotgunned with taking cherry extract pills which also didn't work and were stupidly expensive. I had high hopes for cherry extract because cherry juice almost works.
- I did get relief out of tart cherry juice which I really enjoy but it had two serious downsides. First, for me anyway, it's a super good laxative which I've filed away for future reference. Second, the high sugar content meant that the resulting upswing in pain was nigh unbearable, especially when paired with food.
- Dried cherries and other suggested fruits (dried pineapple, fresh apples) didn't help.
- Beet juice may have worked. I took this with other remedies that did work so I can't really be sure. Like I said, I didn't do real science here. Beet juice is also a laxative and with such a "fun" combination of dietary experimentation, I spent a lot of time counting the planks in my bathroom and finding all the places where the previous owners did a lousy paint job. Beet juice also tastes awful.
- I pulled "baking soda in cold water" off of a couple sites that had additional warnings. This did work, and worked really well, but the additional warnings were warranted. I had serious blood pressure spikes doing this and I used this remedy for about five days. It works almost too well, usually giving relief enough to get a shoe on and to drive for short distances which is why I kept doing it despite the dangers. It's worth noting that it also tastes godawful.
- Icing the affected toe would make it numb enough to not feel pain for a short while but once temperatures were more normal, the pain came back with a vengeance. It might be that the external pressure of icing increased the trauma but I stopped doing this after two days because it hurt too much once the icepack was off.
- Straight up drinking apple cider vinegar actually worked, probably too well. Bragg's is the readily available one where I live (Cascadia). You want one that isn't filtered or pasteurized that has an active culture or mother. It's not super expensive and it worked within moments much like baking soda in water. A couple shots in the morning and evening before bed was usually enough for a day. If things got dicey between, another shot or two would fix it. I started mixing it with beet juice which strangely made both more palatable. Then I started cutting it with water. At the very end I was drinking it straight up. I don't recommend this. Never in my life before this have I felt the lack of owning shot glasses.
- Drinking a lot of water also helped. I like to think that kind words and encouragement to my overworked and under-performing kidneys might have also helped. The jury's still out.
- Drinking that same water with lemon seemed to help between vinegar doses. It also tastes pretty good though now I have a strong association between lemon and pain. I'd seen this on a couple sites before finding a biker guy's page who vehemently attested to its efficacy. I've misplaced the page, sadly, but he was right. It's likely that the Vitamin-C has some effect and it's worth noting that humans are one of very few vertebrates that can't synthesize it.
The TL;DR version:
- Avoid beers, sodas, sugars, and carbs.
- Drink vinegar (yuck).
- Drink more than a healthy dose of water and lemon.
Here's hoping that I don't need to refer back to this, ever.