I Am Gout

I have gout.

Maybe I could have come up with a better hook. Some quip or background story about the course and curse of my life. But nah. When your foot’s swelled up like a goddamned softball and the thought of walking fifteen feet to the bathroom brings on a bout of shakes and sweat like day three of a detox, necessitating a military-style gameplan complete with analysis of terrain and supposition of barriers and where-the-fuck-is-the-dog-because-as-soon-as-I-get-up-she’s-going-to-plop-herself-right-in-front-of-my-route, well, you learn to just keep it simple. I have gout.

Besides, it’s a phrase I have to repeat twenty times a fucking day when I’m having a flare-up. You get used to it.

“Why are you limping?”

“I have gout.”

“What happened?”

“I have gout.”

“Hey… Umm.. Are you…”

“Yes. I have gout. I am gout. I am Groot.”

Because nothing devolves into a one-line talking tree more quickly than a seemingly healthy forty-something hobbling around like Yoda in Return of the Jedi, right before his cloak withers around his flesh dissolving into the ether. Is that my best pop-culture old man reference? Yeah it is. What, should I have gone with Citizen Kane gasping out about his stupid sled? Well that movie sucked. I don’t care if it ranks #1 all-time. It was boring and can’t hold the jockstrap of Casablanca and The Godfather, the other two that it usually muscles out for the top spot. Yoda’s a better reference, because every Star Wars movie is better than Citizen Kane.

(Editor’s note: By “every Star Wars movie,” I mean episodes four through eight, and maybe Solo and Rogue One. The others don’t count.)

(Editor’s postscript: I can make editor’s notes that say “I” because the writer and the editor are the same person in this masturbatory act of self-publishing.)

My first bout with gout (hey, a rhyme) came in my mid-thirties. I was still single and living alone meaning, unlike now, I couldn’t ask my wife to take the trash can out to the curb just this once. Hoo boy. I remember that Lawrence of Arabia-esque trek toward the curb.

“Aqaba! From the land!”

“Trash can! To the curb!”

“You are mad, sir!”

BTW, Lawrence of Arabia is also a damn fine movie and should be hundreds of places higher than Citizen Kane.

The journey to the curb was bad enough, because at least I could use the trash can as a pseudo-walker. Hobble, hobble, move the trash can six inches. Hobble, hobble, move the trash can six inches. Fifteen minutes later, I turned around with horror to see the wide open expanse of my driveway leading back to my front door. Nary a stabilizer nor support lay betwixt myself and my goal. The December ground was wet with light drizzle that was ongoing, yet still the prospect of getting down on all fours and crawling back into my abode seemed a perfectly viable alternative, and if my pants became shredded and knees bloody, it seemed a small price to pay. After all, I could always shower once I… wait, showering requires standing. Never mind, I guess I’ll just hobble back for twenty minutes and risk pneumonia. They hospitalize you for that, right? Bedridden for the next week sounds like an excellent gameplan during a flare-up.

That flare-up was a particularly bad one. It had started in one ankle, but after a few days of favoring the other foot while walking around, I now had two ankles the size of softballs. Walking around with one painful foot is difficult. Walking around with two painful feet is a simultaneous exercise in futility, frustration, and misfortune. I believe Chasing Amy refers to that as a Chinese finger trap.

That trash night was followed by my first ankle-related doctor visit. Which is saying something, because as a mid-thirties American male, I didn’t believe in going to the doctors for shit. There’s a reason any plan to make insurance affordable starts with making young men pay for it, because everyone knows they’ll never use it.

The doctor brought up this newfangled diagnosis called gout, but she was hesitant to classify my current condition as gout. First she had to run a thousand tests, which required my gimpy ass to drive all over town to different medical offices and hospitals, most of which had parking lots over a block away from the institution. I had to go to the x-ray guy to see if anything was broken, and the ultrasound guy to see if my leg was pregnant. Or maybe she was looking for a blood clot. Regardless, my leg was neither clotted, nor knocked up.

So then the doctor gave me a pill that I had to take once every hour until one of two things happened. Either the pain would go away, meaning I have gout, or I’d get sick as hell. And how about another “Hoo Boy” for that one. I said “sick as hell” instead of “sick as shit” for a reason. Because all of a sudden I was spewing out of both ends like Old Faithful. And believe me when I say it was “all of a sudden.” I went from zero to a million in the time it took me to crawl the ten feet from the couch to the bathroom. What started as a vague sense of “something’s not right” quickly became a pinwheel spinning from ass on the seat to face in the seat to ass on the seat and praying that there would always remain a split second between the two phenomena. But as I kneeled next to the porcelain goddess after the seventh flush, I remember wiggling my toes and still feeling the pain and thinking, “well, at least I don’t have gout.”

It would take five years, and at least three doctors, before that “not gout” designation was reversed. And no, I wasn’t doctor shopping or anything, I was just going from one insurance plan to the next based on whichever one was cheaper. It’s not like I was going to use it, anyway. Although when the second doctor only diagnosed me with a case of “you walk funny, get some orthotics,” I decided to find something more permanent. Plus, I switched to Kaiser, because then if I had to go through another bout of tests, they’d at least all be in the same building,

So now, a decade later, I can just say I have gout. Well, sort of. Because my form of gout doesn’t fit any of the normal descriptions. The only thing that made me finally admit, begrudgingly, that I may in fact have this particular affliction is that gout medicine usually helps me get better.

Gout is a form of arthritis. A flare-up happens when there’s too much uric acid in your blood. The uric acid usually falls toward your foot, creating a dull pain in the toes. And there are a few times I feel that. It’s a deep discomfort, almost a stiffness, that appears in my toes. It makes walking more difficult, but it doesn’t necessarily get better or worse if I walk. It’s always there. And at those points, I think, “Yep, that’s what WebMD and Wikipedia tell me gout is.”

But those textbook gout feelings are rare. My usual modus operandi hits my ankles, not my toes, and causes them to swell up to the point that flip-flops are the only footwear that can contain them. Sometimes, but not always, this is accompanied by a sharp pain in the arch of my foot or my heel, like plantar fasciitis. But usually I chalk the arch and heel up to continuing to wear shoes, and oftentimes an ankle brace as well, which bruises my swollen foot.

Are you uncomfortable yet? Grab some Advil.

Gout is usually caused by diet, and a flare-up usually happens after eating something bad. But mine is usually caused by rolling my ankle. It can be slight or severe. Sometimes I step on a rock and my leg kicks out while my foot stays still, and I know that three or four  days later, my ankle’s going to be spherical in shape. Other times I feel the twinge and try to think back as to what I did over the last few days and can’t pinpoint what exactly I did. Even if I can’t pinpoint the incident, I don’t think it’s usually tied to food.

Except maybe salt. I’ve definitely noticed an increase in discomfort, and even an occasional outbreak, after I overindulge in salt. Whether it’s dinner at Panda Express or processed lunchmeat sandwiches or hitting the sunflower seeds too hard at a ballgame, you can bet I’ll be wearing an ankle brace the next few days.

Oddly enough, though, salt isn’t listed as one of the key ingredients that brings on gout. The magical elves at Wikipedia list red meat and shellfish as the cause. Do I like red meat and shellfish? Sure. Do I eat them a shit ton? Not really. Sure, I love me a hamburger, but my pasta sauce and homemade tacos are just as likely to have chicken or turkey. And while I’m definitely the guy at the crab feed that the organization doesn’t come out ahead on, I can’t afford to eat crab or scallops or shrimp more than once or twice a year. And the type of red meat they they usually reference on the gout sites are the nasty shit – livers and kidneys. And sweetmeats, which I’m pretty sure are fucking brains. Eww. Never ate that shit and probably never will. Definitely never will, now that I know it’ll inflame my gout.

What’s that? Beer is also listed as one of the irritants? Because of the yeast? Why are you bringing that up? Seems completely irrelevant…

So let’s go down the checklist.

Dull ache in my toes? Nope.

Eat a lot of cow brain? Nope.

Discoloration of the gap between tiles? Oh sorry, that’s grout.

After years of reading all of the descriptions of gout and thinking, “that’s not what I’ve got going on,” someone saw me hobbling along and asked if I had bursitis. I said, “No, I have gout,” then immediately looked up bursitis. Well, not immediately, because it probably took me ten minutes to go the fifteen yards to a computer. But “immediately” in gout world.

Bursitis is the swelling of the bursae fluid sacs at the joints. Symptoms include a stiff ankle, swelling of the heel, hot skin, red skin, veins popping out, pain when wearing shoes.  Ding, ding, ding! Winner, winner! I mean, not really a winner, because it’s not exactly a prize, but at least the symptoms sounded a lot closer to what I had experienced off and on for years. Why the hell does everyone want to diagnose it as gout when it’s clearly bursitis?

Hold on, let me read a little further. Causes of bursitis may include… gout. Well, fuck a duck. They might want to add that little footnote to all of the gout descriptions that say it’ll hit your toes first.

I also got it in my knee once. That was fun. While curling (actually, while sweeping), my lower leg went the wrong direction, and three days later, I could barely put on pants. The left knee is still a little bit tender, but at least it has the decency to confine itself to one side of my body, a concession my ankles rarely make. Still, nothing makes me feel quite so alive as those days that I’m wearing two ankle braces and one knee brace. I’m like Cyborg or Robocop, mostly machine with only a trace of humanity remaining.

I’ve become more adept at predicting when these outbreaks will occur. I’ve even been able to avoid a few major flare-ups. I usually feel a twinge in one or both of my ankles, and I immediately cut down on its usage. Sleep on the couch with my foot propped up above my heart for a couple nights, maybe a little ibuprofen and some ice, and a few days later, I’m fine. The acronym for a hurt ankle is RICE: Rest, Ice, Compression, Elevation. I repeat it over and over like the episode of Family Ties where Mallory learns the acronym for SCUBA.

If the twinge is a little bit worse, I can take my indomethacin prescription pills for a couple days. But not more than a couple days. Because if I have to get a refill more than once every two years or so, my doctor might want me to come back in for a closer look. And while I’m now in my mid-forties, I’m still male. Besides, you can’t drink alcohol with these pills. And it’s not just a suggestion, it’s a vomit-fest.

But whenever that happens, whenever I feel the gout coming and can avoid it with a little bit of precaution, I think to myself, “Whew, I’ve finally nipped this thing.”

Then the gout responds, “Oh yeah? You think you’ve got me under control? I hope you weren’t planning on going upstairs anytime soon. And have fun honing your cruise control skills.”

Because if I’m distracted or unable to take it easy for a few days, the gout hits a tipping point, and then it’s going to take a week of indomethacin and ibuprofen, not a day. Or longer. My current discomfort’s been going on for a few weeks. I thought I was getting better after four days and quit the pills for a day or two. Oops.

The last major incident before my current stroll down no-stroll lane came last February. It was the week of the Mock Trial competition at my school. I am the Mock Trial coach. Not much I can do to avoid being out and about for fifteen hours a day. Oh, and the parking garage is a block away from the courthouse, because they used the same ableist, piece-of-shit civil engineer as the hospital. I resorted to using my wife’s grandfather’s cane. Nothing says hip, with-it, and in control of one’s faculties quite like a circa 1970s wooden cane that looks straight from a Tijuana street vendor. Can I get a pimp cane to go with my pimp walk?

What made it even more sublime was that the Mock Trial case involved the defendant’s walking stick being used to bludgeon the victim. Some of the opposing teams joked that I was bringing in an inadmissible prop. Until they saw me walk. Then they asked me what was wrong.

“I have gout.”

But the cane did little to help me walk. It helps when I’m standing in front of the classroom, because then I can lean on it. But when I’m walking, it does virtually nothing to alleviate the basic problem of moving my foot through the air and placing it upon the ground. The amount of weight I put on the foot might doesn’t really affect the amount of discomfort. If anything, the cane makes it a little worse,  because in addition to pain, my foot also lacks strength. The cane fixes the latter, meaning I can walk faster, but does nothing to alleviate the pain, which is now happening more often. I’m sure, with more experience, I could be more effective with the cane, but at this point, I’m still a neophyte. Hell, I can’t even figure out if I’m supposed to use it in the hand that’s on the hurting side or the strong side.

This week, I finally broke down and bought one of those knee scooters. You know the one? You cock your leg and rest the lower half on a raised scooter. Totally fancy, and even moreso, it allows my infected foot to never touch the ground. Of course, it also puts pressure on my knee and must do something wonky with my bloodflow, because when I do finally put the infected foot down, it’s a dazzling shock to the system. A sharp pain from an appendage that thought it was getting the day off.

Oh, and the knee scooter doesn’t help with stairs.

Oh, and it looks really silly. I know, I know. That totally shouldn’t matter. If I’m already gimping around, why am I worried about appearances? Because I’m a vain motherfucker. And generations of badasses from John Wayne to John McClain to John… umm… McCain? have told me that walking with a limp can be manly. Swagger! But only pussies would ride around on a scooter.

Wait, Fonzie drove a motorcycle, right? So all I need to do is invest in a leather jacket! Unfortunately, I just bought a knee scooter, so there’s no fucking way I can afford a leather jacket.

I’ve had a few other flare-ups at bad times. They always seem to happen at bad times, because if it’s a time where it’s convenient for me to slow down, it doesn’t go into Full Gout Mode. They also tend to happen when I’m distracted. When I can feel the twinge and think, “Oh, that’s not the gout. It must just be the…”

One time was in England. I blamed it on all of the traffic circles, because driving a stick-shift on the wrong side of the car is bad enough, but needing to slam out the clutch to go from zero to fifty in a half-second in order to negotiate the two-yard gap in a continuously streaming cross-traffic is not beneficial for somebody with traditionally wonky ankles.

Sorry. Two-meter gap. Yards are outlawed in Europe.

It coulda been the salty Nando’s, too. Mmm… Nando’s. I’d chop off my ankles if it meant I could get a Nando’s here on the west coast.

The ankle got worse and worse, and by the night before we left, it was horrible. And the Bristol airport puts their rental car lot even further away from their terminal than do northern California hospitals.

When we got to the counter, my wife told me to ask for a wheel chair. I was very reticent for the same reasons I don’t want to use my knee scooter. I hate looking like an invalid. I hate needing others to push me around. I’d rather have to let little old ladies pass me than to throw in the towel. Because if I’m in a wheel chair, people will avoid eye contact with me. But if I’m limping, they’ll ask me what’s wrong.

“I have gout.”

But Wife insisted, and there I was, being pushed around by my wife, who was four-weeks pregnant at the time. And a little bit hungover, because we didn’t know she was four-weeks pregnant at the time. Makes me feel like an abusive husband. Barefoot, pregnant, and pushing my ass around an airport.

But it’s a good thing we did that. Because the airport staffers called ahead and when we got off the plane in Atlanta, there was a wheelchair waiting for me. This time it was pushed by an airport employee, because evidently capitalist America hires people for those roles, whereas socialist Britain tells you to do it your own fucking self. The wheelchair pusher had some clout. He pushed me past the milieu and, most importantly, to the front of the customs line. Holy shit, I should ask for a wheelchair more often. Then he took me out of the international terminal onto a tram and all the way to my domestic gate. Had I attempted this journey by myself, it would have taken me three hours. I would have missed my connecting flight. So fuck you, John McClain. If you missed your connecting flight, then Hans Gruber wins. And if Hans Gruber wins, then there’s no incentive for him to get a job at a wizarding school and not one, but two movie franchises are ruined.

“You feel that, Butch? That’s pride fucking with you. Fuck pride.”

Did I just go full Bruce Willis circle on that? I did!

My other experience with wheelchairs came two summers ago when the gout stuck while we were vacationing in San Diego. San Diego in summer. Totally the time one would expect to get hit with a form of arthritis that is exacerbated by the cold. And there’s not even any cow brain on the menu there!

The two places we wanted to take our child in San Diego were the zoo and Legoland, two places not known as favorites of the immobiles. Wife again insisted I get a wheelchair at both places. And good God, y’all, did you know they have hills in San Diego? The San Diego Zoo must have at least ten different elevation changes of a thousand feet or more. The polar bear exhibit is halfway down a hill that is approximately a mile long and at a seventy percent incline (I’m not a geometrist), so if I wanted to see them, my options were either to start at the bottom of the hill and relive the story of Sisyphus or else start at the top of the hill and run some fun experiments on terminal velocity.

And then there was that whole pride thing, again. I didn’t want to make the bus stop for me and take the time to load and unload my wheelchair. I didn’t want to ask for help from strangers, and Wife was busy single-parenting a three-year old who wants to see all the animals at the same time. So there I was, going up a steep incline using the poles of an iron fence to pull myself up, which I had quickly realized was much easier than pushing the wheels uphill. So yay for leveling up in wheelchair faster than I did in cane. But holy crap, if I had to be in a wheelchair every day, I’m pretty sure my upper torso would look like Rambo’s.

The following day, we went to Legoland. Again, we rented a wheelchair. There are fewer steep hills at Legoland, but it seems like the whole damn place is on a slight slope. There were very few places that I felt comfortable taking my hands off the wheels without worrying about gravity pulling me slowly away from my family.

But I did find out one pretty cool thing. Most Legoland rides have a separate line for disabled people. I don’t know if I technically counted as disabled, but I was definitely mobility-impaired, which was the main thing they were concerned with. Or maybe they just felt that since I paid $50 to rent the wheelchair equivalent of rental skis, I shouldn’t have to stand for long periods of time in line.

So I got to go to the super secret disabled entrances to rides, which aren’t really all that secret, but are very, very super. For most of them, you go the then end of the line or the end of the ride, where people get off the ride. And then, just like customs at Hartsfield-Jackson, you’re magically next in line. There were a few rides at Legoland that had a Fastpass-style disabled entrance, where you’d sign up for a time to come back. But unlike the real Fastpass, the time is twenty minutes from now, not two hours. And twenty minutes turns out to be just enough time to skip the line at the ride next door and come back.

Hey, wait a second. We’re taking our kid to Disneyland in March. Maybe I can rent me a wheelchair and become Dad of the Year. I remember all those stories a few years ago that wealthy families were hiring disabled people to skip the lines for them. Can I hire myself out? I assume Disneyland is a bit more scrutinizing than Legoland, but I’ve gotten the royal treatment once before.

Then again, at the rate my last week has gone, it might be wiser for my family to keep me at the hotel. Or leave me at home.

I guess in the meantime, I’ll do what I do best at times like this. Sit in pain and wait for the drugs to go into effect.

Say it with me: Rest, Ice, Compression, Elevation. Rest, Ice, Compression, Elevation. Self-Contained Underwater Breathing Apparatus.

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