Out Gout Now
The shame must die
Perhaps all societies stigmatize disease and examples are legion. I write today to say one disease is so stigmatized that literally nobody talks about it—gout—even though ~4% of Americans suffer from it.
I happen to the think the stigma links back to the word itself—GOUT. Just saying it 3-4 times in succession summons a sensation of nausea . It’s the gonorrhea of arthritic diseases—you don’t need to know what it is to know you don’t want it. “Gout? Yeah, never heard of it, but sure sounds disgusting.” It invokes Dickensian images of public latrines in the London slums, and it sounds like something your kid might catch from eating boogers, or, worse yet, his or her classmate’s boogers.
Yes, gout is an arthritic disease but also one that links back to lifestyle choices: excess body weight, alcohol and greasy food consumption, and poor physical fitness being among the risk factors. But I am a bright shining example that gout can indiscriminately strike literally anyone. Yes, yes indeed it can. I am an example of that. So beware.
Ok, ok, maybe I have some risk factors. And yes I do take comfort in the fact that Isaac Newton, Queen Victoria, Thomas Jefferson, Beethoven, Alec Guiness, Lawrence Olivier, and Benjamin Franklin, among many famous others, were sufferers, the last suffering so much pain from the disease that he was carried around by convicts. Dick Cheney is also a sufferer and rumor has it that a gouty toe stubbed on a big rock caused him to inadvertently spray his best friend’s face with bird shot those many years ago. Some people are saying, anyway.
Here’s the science: purines, organic compounds present in foods like red meat, beer (especially), wine (maybe), asparagus (maybe), spinach (maybe), seafood, bacon, and organ meat are converted into uric acid in the body. You’ve probably heard one thing or another called a “Gut Bomb;” well, the bacon-double-cheeseburger-IPA special at your local watering hole should be listed on the menu as “Gout Bomb,” accompanied by the disclaimer “don’t say we didn’t warn you.” Uric acid crystals precipitate from the blood and accumulate around joints where they basically act like ground glass. The most commonly affected joints are the ones of the big toe, which just so happens to be the coldest place in the human body and where uric acid solubility can be expected to be the least (warmer temperatures usually favor solubility of about everything). The crystals can also accumulate in soft tissues and I think this is the case with me, as the ends of all my toes on the affected foot are in pain during an episode.
I’m lucky because I am not a chronic gout sufferer. I’ve had a handful of episodes since the first one in 2008, which was by far the worst. I had gone hunting for morel mushrooms and donned a pair of too-tight rubber boots that annoyed my golf-ball-sized bunions. My mother, siblings, and children all have these hereditary bunions and my mother had recently had one surgically reduced (a surprisingly debilitating procedure), and so my mind immediately settled on that diagnosis—painful and arthritic bunion. I was still running pretty regularly at the time and surmised that also had contributed.
I writhed in pain on the living room floor for hours. I kid you not, I remember that pain more vividly than I remember the loss of my virginity, which, come to think of it, maybe isn’t saying much since I don’t remember that at all. I could not tolerate so much as a bed sheet touching my foot the night of that first gout attack; I would later come to find out gout sufferers commonly characterize the pain in this way.
After three days and nights of this, I made a doctor appointment. He immediately diagnosed me with gout and I was like ‘you gotta be f-ing kidding me’ since I assumed this was a disease of fat old guys, and at the time, my body was not the train derailment it is now.
Doc: “Yeah dude, gout. How bad do you want this to be gone?”
Me: “Like my mother-in-law before the kickoff of the 3 pm football game on Thanksgiving Day.”
Doc: “Yeah, pretty bad then. I can prescribe something, but you have to be sure you want it.”
Me: “Give it to me.”
Doc: “You have to be sure you want it.”
Me: “Give it to me.”
Doc: “You have to be sure.”
At this point I’m wondering if a shaman is about to enter the examining room with a tray full of bamboo slivers to be shoved under my big toenail, or some such similarly painful remedy.
Doc: “It’s called colchicine and the British used it to kill rats on the HMS Cornwallis in the War of 1812.”
Me: “So, rat poison.”
Doc: “Yeah. But you’re not a rat and you only have to take it every four hours until the pain subsides, about 3-4 days usually.”
At this point I considered riding it out without the rat poison, but ultimately decided otherwise and left the office with the prescription. Six hours later, I’m wondering why the medical community hasn’t yet discovered the use of colchicine as a colonoscopy prep. But, just as the doc predicted, I woke up three days later with my foot relieved of pain, but with the rest of my body feeling like Vladimir Putin’s hit squad had been preparing my meals.
A ballpark guess is that I’ve had one attack per year on average since then, and was able to ward off some impending attacks by taking a few rat poison tablets that I saved from the first go-round. I can’t put it into words very well, but I get this ‘gouty’ sense of dread a few hours before the onset of an episode; imagine, if you will (if you’re a man), a yellow jacket landing on your man parts while you relieve yourself in the great outdoors. That level of dread.
I finally exhausted the rat poison pills a couple of years ago and made an appointment to get more. I had moved since the first episode and thus had a new doctor by then. This new doctor was a guy about my age and seemed about like me in most other respects. “Colchicine, eh. Yeah, I take that too.” Then he showed me the secret gout handshake and read me the sacred oath of initiation into the Brotherhood of Goutians. ‘Suffer in Silence’ is their motto. He said I could take a small dose of one rat poison pill per day as a prophylactic, if I was so inclined. Once in a while “the dread” will inspire me to do that for a few days but I have mostly avoided that strategy.
At any rate, I think it’s high time that gout sufferers unite to “out the gout.” We should not have to suffer with shame, and in silence. As such, I’m calling on Crocs, Berkenstocks and any other makers of loose-fitting shoes to fund an awareness campaign targeting the public’s misperceptions about the disease. These shoes help us leave the house, and give us the dignity to go on about our lives in the face of this debilitating malady.
About my book: The Swine Republic is a collection of essays about the intersection of Iowa politics, agriculture and environment, and the struggle for truth about Iowa’s water quality. Longer chapters that examine ‘how we got here’ and ‘the path forward’ bookend the essays. Foreword was beautifully written by Tom Philpott, author of Perilous Bounty. Choice of free book copy or t-shirt for all paid subscribers to this Substack ($30 value).
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Birkenstock makes shoes, and I love mine. I can’t believe I might have to quit drinking IPA, though. 🍺