Disgressed

Last weekend as I was lying in bed I felt some little twinges in my right foot.  I thought little of it, really. I’ve had trouble with my feet before, though mainly on the left.  A year or two ago I was referred to a physiotherapist who, in essence, told me my feet weren’t on straight. If my knees are pointing forward, my feet point outwards, one only slightly and one rather more.

“To be honest I’m surprised you haven’t noticed it,” said the physiotherapist, “I would have thought you’d have had problems with that years ago. If we’d spotted that when you were ten years old, we would probably have taken a saw to your leg and tried to put it back straight; these days we know that just causes more problems. There are some pretty big bits of cartilage and stuff in there, so it won’t really fall apart or anything.”

Experience showed that so long as I wore shoes which were reasonably tight across the foot, I didn’t have any problems; it was only walking a long way in loose or no shoes that I had to avoid.

So a bit of twinge or so in the foot is not something I was worried about, and indeed in the daytime the feet were fine. But on Sunday night, as I got into bed, it suddenly felt different and worse.  A strange and nasty pain was suddenly making itself felt. It seemed like a sort of strain, but there was no position that really made it better: the best I could find after several trials was lying on my back with my leg bent and held there by my hands clasped in front of my shin. This is not a position in which you can readily fall asleep.

This didn’t feel like the other problem: in fact it felt very much the way I imagined gout must feel. On Monday morning the doctor listened to my descriptions.

“You’ve got gout.” he said, “No doubt about it: absolutely typical. The location in the big toe joint, the sudden onset, how it looks, your age, even the thing about it being worse at night and when lying down.”

And you being overweight and drinking too much, he didn’t add – but he thought it.

“How much are you drinking these days?” he asked, evidently following a similar chain of thought.

“Oh, I don’t know. About 25 units?”

“Oh – that’s down a bit, isn’t it?”

Down a bit? Have we talked about this before?

“Anyway, what we’ve got here is that the breakdown products of DNA in your bloodstream, which normally get flushed away, are accumulating and turning into crystals in the joint. The treatment is to drink lots of water to help flush it all out. Rest the foot. I’ll give you some tablets which should clear it up fairly quickly.  In the longer term, watch the diet, not too much red meat or shellfish, keep the alcohol down a bit. There’s a good website with all the details: I’ll write it down for you.  Some people only ever get this once, but I’m afraid the chances are that in eighteen months or a year or so, you’ll find it suddenly comes back again.”

A cheery prospect.

The pain is actually very varied and, as it were, phenomenologically interesting: sometimes it feels as if I’ve stubbed my toe quite badly, sometimes there’s a stabbing pain, and sometimes there’s that indescribable bad sensation, that abstract essence of what you really intensely don’t want.  For a while during the day it sometimes feels exactly as if I’ve grazed the top of my foot and toes quite badly and have a plaster on (which I haven’t). Sometimes it’s quite mild, at other times, especially at night, it’s insistent and if you touch the wrong place the foot, which you’ve been trying not to move, goes into a sort of spasm all on its own which triggers a generous rush of the unpleasant abstract essence thing. I spent three night sleeping in an armchair because lying down just wasn’t working.

I finally gave up on going to work and took Friday off, which was a good idea; apart from resting the foot it saved me the tiresome process of explaining to everyone I met why I was limping. With rather limited amounts of sleep I was getting I probably wasn’t at my best anyway.

The dietary position is a bit odd: it’s good to lose excess weight, but the things that are perfectly OK from a gout point of view include cake, chocolate, and especially dairy products – not really slimmer’s foods – while lentils, cauliflower, and some other veg are bad.  On the drink front, beer is clearly the worst thing while some research suggests that unfortified wine in reasonable amounts does no harm at all. Actually, although lowering the intake of purines (the aforementioned DNA breakdown products) does seem to help, the problem is actually more complex, with some people generating too much of the stuff and others just unable to get rid of it.

Anyway I think the current attack is now on the way out: I can walk almost normally; the foot doesn’t actually hurt, it just feels a bit strange; and last night I actually slept in bed!