...but good, the gout did.
The discerning reader will notice that my posts have been shorter, and there haven't been very many of them for the last week.
That is because of gout.
For those unfamiliar with "The Disease of Kings" as it was formerly called, gout happens when excessive uric acid from incomplete digestion builds up in the blood serum, and precipitates out in the form of crystals in the joints, particularly the joints of the big toes and the knees. Since our joints are supposed to work smoothly, with lubricated cartilage on the ends of the bones, adding crystals in there is like pouring sand into your car engine: it ain't running long afterward, bro.
If you've been misinformed, you will have heard that gout is entirely related to diet, specifically a diet rich in animal protein. This is why it used to be known as "The Disease of Kings", because only the nobility could afford regular meals of animal protein in the old days, the peasants ate their groats and fibrous veggies to try to power themselves for their rude existences.
The dietary theory of the disease would be true, if we were all products of our diets, as the food faddists would have you believe.
We're not.
There are several other things that factor in, like the digestive efficiency of one's colon (warning: shitty subject ahead!). When the colon is doing a proper job, 35% of the body's digestion occurs there, which translates to 35% of the uric acid byproduct of digesting protein is eliminated there. When the colon isn't doing it's job properly, or, as in my case, one has had to have a section of the colon removed, one is already behind the curve for eliminating uric acid.
Enter modern pharmacology. Specifically, the drug Allopurinol. When it is taken into the body, it causes the protein digestion to end a step before the last one, the production of uric acid. The final step then becomes production of purines, something like an amino acid, which are very easily eliminated by the kidneys.
The problem is that Allopurinol is affected by damn near any other drug in the body, and as a diabetic, hypertensive with excess cholesterol, I take other meds to keep myself on an even keel. I have several bad discs in my spine, and I have some chronic back pain, so I take a daily dose of painkillers, currently Acetaminophen (Tylenol) to manage that.
So, if everything is in balance, I walk a thin line between any of several health crashes that, while not life-threatening, put an end to normal daily activities such as going to the range, etc when they occur.
It's when the body and all that pharma gets out of balance, usually caused by a virus of the intestinal kind, that it gets interesting, because that's when gout raises it's ugly head. Gout can be small, just twinges in my toes that tell me not to take my daily WarWalk, or it can kick my ass severely, causing me to spend days in bed, leg elevated, madly guzzling water (to try to flush out the uric acid) and trying to deal with the fact that is VERY painful to walk to the bathroom and whiz.
This past week I have been kicked. To the ground, then kicked some more while down.
I had to seek medical intervention. So, as soon as I could sort-of-safely drive, (I'm by myself as the rest of the family is touring in Japan), I motor yesterday to my HMO's clinic, and the doc listens to my sad tale, notes the swollen knee that is hypersensitive to touch (and it is MUCH better than two days ago, I'm actually on the mend), and especially notes that the affected knee is warm, almost hot to the touch.
Hmmmm, says doc, could be an infection in the knee. Gout, I say, maybe osteo arthritis resulting from gout. Could be an infection, she says, have to eliminate that possibility. Soon, a corpsman (sorry, lab tech, I had a flashback to military medicine there) comes in and sucks a ton of blood out of my arm and off it goes to the lab. Stat test, very low white cell count, no infection showing in bloodstream, anyway.
Not good enough, says doc, we have to be really, really sure there's no infection in the knee itself. I get a dark premonition. I'm right. They have to "drain" my knee. That's a polite way of saying that they are going to stick a sharpened sewer pipe in there and suck out whatever fluid shows up at the end of the sewer pipe. Really, it's only a hypodermic needle, but they quit using that size of needles on humans back in the Civil War.
Trouble is, they can't do this at the clinic, because none of the docs there are orthopods who know the knee structures well enough, running blind, to guide that needle in between the vital places and get to where the fluid is, without damaging anything permanently.
I whistle up my oldest daughter, who is about to get off work (she is an RN, on a neurosurgery team at another hospital system in the area), and she comes down to transport me to the clinic's mother hospital 10 miles away (I figger I won't be able to drive back after getting "drained", and it will be a dark and stormy night by then, with T-Day shoppers dashing hither and yon). We get to the ER at the hospital, and after ONLY about 3 hours of useless drone chores like paperwork, getting put into the triage system, etc, I get to see the ER doc who is going to do the needling.
ER doc 'splains it all, very carefully, giving me plenty of opportunities to say "fuckit, that's just too invasive for an investigational procedure", but I don't say the words. A grizzled old male nurse that I can easily envision having hauled shot-up soldiers off of foreign battlefields under fire comes in, and he is to assist. We banter while the doc sends out for the sewer pipe/needle.
I get HUGE doses of Lidocaine shot into the knee. Doc jabs me with the sewer pipe and I don't feel it, FOR ABOUT TWO SECONDS, then the needle hits a structure that didn't get any Lidocaine, so out comes the needle, gets filled with more Lidocaine, and back in it goes, hosing the pain-killer as it penetrates, firehosing it really, because this needle is about the size of a fireman's nozzle on the end of a 4" diameter hose.
The needle, expertly guided up to now, finally runs into a bone. Bones have their own nerves, not affected by Lidocaine, did you know that?
I KNOW THAT NOW, THANK YOU VERY MUCH!
We do about 15 minutes of this probe-and-suck routine inside my knee, with, maybe, 5 or 6 of those max-pain bone hits. I'm no dummy, and realize after the first bone strike that if I jump again, I'm just going to get damaged more. I try deep breathing. Helps, but not much. I try panting, helps a little more, but not enough. Then I see the duck.
There's a duck on the ceiling tile, an imperfection of the tile in the perfect shape of the AFLAC duck. I start talking to the duck, I concentrate totally on the duck, and we have a fine conversation, and the nurse, doc and daughter must think I'm nuts, but I'm not jumping anymore when the needle strikes bone, I just talk to the duck.
That, readers, is a metaphysical state called "detachment", and I learned it in the USAF's POW training camp for aircrew who might be captured by ComBloc forces and get tortured. We listened to several ex-'Nam POWs tell us how they used the technique, then the instructor cadre introduced us to some pain, and we got to practice it. I was amazed last night that it still worked for me, but it did.
I got up and walked out of there, and breezed through the trip home, because the Lidocaine in the knee wiped out all the gout pain AND the pain of the needle damage, which I knew would come back to haunt me.
I went to bed at 11 pm. At 2:45 am, I got up to whiz, and when I put my leg out of the bed, I almost screamed. Gout plus tissue needle damage, plus the bone sticks, I can feel it all. No more sleepy-bye for me.
So, here I am, blogging at oh-dark-thirty, two hours to dawn yet. I started up the painkiller ladder that the ER doc left me with, and I'm one rung short of the top, which is OxyCodone, which I don't really want to have to take, because I will get hammered on it, and I still have to prepare a T-Day feast for three sometime in the next ten hours, and spiff up this pigsty of a house that I have trashed and not taken care of while down with the gout for the past 5 days.
The bumper sticker is correctimundo: "Old age ain't for sissies".