Sunday, 5 December 2010

Gout


When I started having treatment for CLL about 15 months ago I was given a prescription for Allopurinal in order to prevent an attack of gout. Apparently it's common for the chemo to affect the kidneys and prevent them dealing with uric acid, which then settles in your joints, normally the big toe or knee, causing swelling and pain.
After three months or so the drug was discontinued, as the risk of getting gout was reckoned to be negligible by then.

So how come I had an attack this week? I can only assume that it was gout, as the symptoms line up exactly. So what caused it?

Let's go back to Thursday.I had a shower and during the evening I could feel an itching between my toes exactly like an outbreak of athlete's foot. I pulled off my sock and checked. Yes, the skin was cracked so I applied some cream. The next morning my foot hurt. It felt like someone was pulling my big toe off my foot, in the same way that one would tear a wing or leg from a cooked chicken. The joint was swollen and it hurt to put my foot on the ground. I hobbled around during the day and in the evening took to my bed to read my book.

I had a brainwave. Could I be suffering from gout? I'd all but forgotten about the course of drugs I'd had the previous year, but I thought I'd Google "CLL and gout" and see what I could discover.

I discovered that gout is indeed a possibility to anyone who has had chemotherapy. But what brought it on?

I continued looking.

Some foods can cause an attack of gout, including liver. I love liver and onions and we eat it most weeks without a reaction. Then I remembered. I'd bought a larger than usual pack of liver from the local shop and it was far more than we usually eat, so I served three portions instead of two and I ate the second portion on Wednesday night (after eating it on Tuesday as well).
So it seems I could eat one serving of liver without any ill effect but not two.
As I write this I still have to speak to the specialist (rather than my local medical centre- I never see the same GP twice and it's such a pain to have to go through my story every time I make an appointment. The poor GP's eyes glaze over before he/she even examines me, and often they just don't have the specialist knowledge anyway.)

Once I've spoken to a doctor I'll know the way forward. There are two ways to deal with it. The first is a course of anti-inflammatory drugs to reduce the swelling, followed by a course of allopurinol.

The second is much harder. It involves a complete change of diet, and that would be very tough for me. Cutting out alcohol is easy. I've been teetotal for years. Alcohol is not the cause of my gout. I'm pretty certain that it was eating liver twice in one week that caused the outbreak.

There are a number of lists of foods that are said to cause/aggravate gout. The trouble is (twofold in my case) that the lists are different.
For instance, liver appears on one list but not on another.
Cutting out kidney and other offal won't be a problem, but I like liver, so boo.
Cutting out sardines, mackerel, trout cod and salmon will be ok. But haddock?
I love haddock, much tastier than cod.
Red meat is a no-no, along with gravy.
Shellfish is out, along with anchovies.
Even turkey gets the thumbs down.

Why is it that all the food that has taste is barred?

How come cauliflower is barred, along with spinach, but cabbage, kale and other leafy vegetables are ok?

Oatmeal is out- so no more porridge or muesli.
Whole grains are out. So much for healthy alternatives.
White flour is out as well.

The only good news is that chocolate is good for you. So are strawberries, raspberries and cherries

I eat what I consider to be a good diet. Mostly plain food, nothing spicy. certainly nothing that my grandmother wouldn't recognise. I'm not a foodie.

Even so, having a good percentage of my limited diet ruled out is a bit of a piss-off, to be frank, so I'm going to go down the drug route to clear the gout up, and then remember not to eat too much liver at one (or two) sittings.

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