Gouterdämmerung
Badly mangling English and German for a play on Götterdämmerung, the last part of Wagner’s Ring Cycle, “Twilight of the Gods.” Or in my case, Twilight of the Gout.
Really the German word for gout is gicht, so maybe it should be gichterdämmerung? Doesn’t sound as good.
Anyway.
What is gout?
Gout (/ɡaʊt/ GOWT) is a form of inflammatory arthritis characterised by recurrent attacks of a red, tender, hot and swollen joint,caused by the deposition of needle-like crystals of uric acid known as monosodium urate crystals. Pain typically comes on rapidly, reaching maximal intensity in less than 12 hours. The joint at the base of the big toe is affected (Podagra) in about half of cases.
I suffer from it. Have for about a decade. 2–3 flare ups a year. Not that serious, a week or so of hobbling around. Big toe joint inflamed. Very painful. Kind of used to it. Funny the things we get used to.
Why “twilight of the gout?” My problems may be at an end soon. I’ve been prescribed allopurinol. Prophylactic used to decrease uric acid. That’s what causes gout. Excess uric acid forms needle-like crystals.
My blood test shows elevated uric acid levels. Hyperuricemia. There can be a number of causes, genetic to diet related. Excessive consumption of purine rich foods. Mostly red meat, offal, shellfish and alcohol. Beer and wine particularly.
I haven’t been eating steak and burgers every week or drinking heavily but my diet hasn’t been consistent either. There are times when I’ve consciously overindulged, knowing a gout attack wasn’t going to be far off. Prepared to hobble around. Not a good approach considering long term repercussions, which include permanent joint damage.
I had a wake up call recently. The mother of all gout attacks. While in Hong Kong, eating and drinking all the wrong things. I wrote about it almost a week in, hobbling through Hong Kong airport on my way to Taipei.
It didn’t subside. The big toe joint on my right foot remained inflamed. I stubbornly carried on, moving from city to city. Taking ibuprofen and hoping it would clear the next day. And then the next. Just one more day…
Hobbled 30 km over 3 days, through walking tours and towns in Taiwan. In a lot of pain. Dragging my right foot along behind me.
After going from Taipei to Hualien to Taitung, hobbling from 2023 to 2024, 12 days into the attack, I had had enough. It wasn’t getting better. I was spending most of my time in hotel rooms.
I went to a clinic in Taitung.
First thing the friendly doctor asked me was “why didn’t you seek medical attention in Hong Kong?”
Yes, why didn’t I? Lesson learned.
Also learned the Mandarin word for gout: tòngfēng. I can now say “hello”, “thank you” and “gout” in Mandarin.
The doctor went with the nuclear option. Prescribed THREE anti-inflammatories, one an oral steroid, as well as medication to handle possible gastrointestinal side effects. Three times a day, over three days. All packaged in individual dosage portions. The dispensary was in the clinic.
The whole thing, consultation and medications, came to around £10.
I love Taiwan.
Within a couple of hours of taking the first dose; for the first time in 12 days, the throbbing pain started to subside. I could walk again! I felt a few emotions.
Next day it was even better. I jumped on the free bikes provided by my hotel and explored Taitung. Finally, I was happy. I was free again.
Another two weeks of exploring Taiwan. Walking. Cycling. Diving. Towards the end I was even back to running! Everything was fine again.
Then it was time to leave Taiwan and fly to New York. 14 hour non-stop flight from Taipei.
Things went fine for about a week. Walking. Running. Then suddenly the pain was back. Same spot, big toe joint in right foot.
Another gout attack? Already?! Come on.
I had been a little lax on diet but still avoiding red meat and alcohol. Had fried chicken at Amy Ruth’s in Harlem (amazing as always). A slice with pepperoni. A little bit of bacon at hotel breakfast. Otherwise avoiding everything high in purines as much as I could. No drinking. One glass of sparkling wine.
Still not good enough. Or my uric acid levels were already too high or had never come down? Maybe the crystals in the toe joint had never fully dissolved? Maybe it was joint damage? Too many questions.
Back to hobbling. Went to a clinic near where I was staying (Financial District). It would be $225 before I could even speak to someone. An hour wait. My travel insurance didn’t have gout as a pre-existing condition so I decided to leave it. I was going to be back in London in over a week. US healthcare is fun. By fun I mean medieval.
Six days later it cleared up. Had a day of walking around Philadelipha pain free. Day after that I flew to London for the first time in almost 14 months. Had an appointment with my GP booked from weeks before when I was in Taiwan. I’d prepared.
Explained everything to my GP. He mentioned that current research was showing that in many cases gout may not be entirely diet related. Some people just have a propensity for high levels of uric acid.
Interesting. For me there did seem to be a causal link between diet and an attack. Particularly the way the mega attack started in Hong Kong. I knew exactly what I’d done wrong and was not surprised at all. In fact tracing back further, there had been minor attacks since the July before. An increase in drinking and consumption of purine rich foods in Melbourne following an accident I’d had.
I wasn’t done exploring all this and what would happen if I did adhere to diet changes.
I was prescribed allopurinol. It’s taken daily, for life. You can’t suddenly stop.
I’ve held off starting this. I want to see what happens over the next few months. If the uric acid levels remain elevated even with diet changes then I will begin taking allopurinol. But I’d like to see if this can be managed without medication. I move around a lot and worrying about repeat prescriptions isn’t ideal, nor is having a dependency on any medication.
I have an added incentive to be more serious about my diet and health. Running. I love it. These diet changes are aligned to all that.
I don’t need to eat red meat. I’ve been increasingly conscious of not just health but environmental effects.
I don’t need to drink. I don’t really want to drink anymore either. Once or twice a year for a special occasion is enough. A sip for a toast. That kind of thing is enough.
Been in Margate for almost a week and just had a minor gout flare up in the same spot for about three days. Not bad enough to make me hobble. It’s been just over two weeks since the one in New York.
Had two large haddock and chips over two non consecutive days. Probably not a good idea. I’m monitoring.
It’s passed now. As of today, as I write this. I ran 6 km on it yesterday.
Let’s see how I get on. The allopurinol is there. I want blood work done again in about three months.
Either way, lifestyle changes or allopurinol, this is gouterdämmerung. The Twilight of the Gout.
Now I just need a Valkyrie to carry me off. There’s no gout in Valhalla.
