In the late 1980’s I worked as a real estate sales director for a firm in Helen, Georgia, and I was the understudy of one Mr. Richard “Dick” Etherton.  He was in his late 70’s, very chauvinistic, and a member of the “Old School.”  I never really figured out just what the Old School was, but I was certain that a young, ambitious, and energetic female was not ever invited to be a part of it.  Dick was angry at the world that he was on his way out professionally and that he, by the order of the owner of the firm for which we both worked, had to train me to take his place.  He was hard on me.  He had a particular penchant for pointing out every little thing I did wrong.  I now understand some of his predicament, but then I thought he was just a grumpy fellow who needed to retire.  Every morning my cheerful greetings were met with his moans and groans about all of his physical ailments as he walked across the floor with an exaggerated limp.  I thought he was making half of it up, but now I know that was far from the truth.  Dick always complained that his gout was getting the best of him.  This was the perfect reason for me to do all of the grunt work around the office and, I thought, a huge excuse for him to have a legal slave.  I did not understand the absolute torture that people with gout actually experience until I started to deal with it clinically.

Gout is a name for a form of joint inflammation (arthritis) that affects primarily the big toe.  The type of pain it causes is inexplicable.  Some compare it to the feeling that the toe is on fire.  Most often the attacks of gout come in the middle of the night with no warning whatsoever and even the weight of a bed sheet on the toe is unbearable.  The affected joint becomes excruciatingly painful, hot, and the skin around it might even turn red and shiny to show the outward signs of the inflammation that is occurring inside.  Gout has been referred to as the rich man’s disease since it is exacerbated by eating rich foods and drinking excessive alcohol, but in recent years it has been recognized to be a complicated and widespread disorder that can affect anyone.  While gout affects mostly men, women are more susceptible to it after menopause.

Gouty arthritis is caused by the deposits in the joints of tiny sharp crystals formed by excessive uric acid in the bloodstream.  Uric acid is formed naturally by the metabolism of purines.  Purines are substances found in certain foods and in alcohol, especially beer and wine.  As the purines are broken down by the body, uric acid develops and in most cases is excreted naturally.  In some cases, though, an excessive amount of the uric acid builds up in the bloodstream and is deposited in joints in the form of tiny needle-like crystals which get into the joints themselves or the tissue surrounding the joints and cause pain, inflammation, and swelling.  The intense pain from gout usually lasts from 5 to 10 days per episode, and there really is no way to prevent attacks once they begin.  Sometimes it can be weeks, months, or even years between attacks at first, but as the condition progresses the attacks get closer and closer together.  Gout can ultimately bring about more intense pain and even joint destruction.  Treatment consists of non-steroidal anti-inflammatory drugs and in some cases steroids to control the acute nature of the attacks.  Most doctors suggest a preventative strategy to reduce the amount of uric acid in the bloodstream and, hopefully, squelch the intensity of future attacks. 

Foods which are high in purines and should be restricted or avoided altogether include organ meats, shellfish, red meats, peas, lentils, and beans.  Excessive alcohol intake should also be avoided, especially beer and wine.  No more than two drinks per day for men and one drink per day for women is a safe bet for those who suffer from gout.  Certain blood pressure medications can cause an increase in uric acid levels in the blood.  If gout becomes an issue and you are taking blood pressure medication, check with your doctor to make sure that the medications you are on are not increasing the likelihood of an attack of gout.  It is also a good idea to increase your water intake if you suffer from gout.  Increased intake of water can dilute the uric acid in your body and ultimately decrease the amount that is in your bloodstream.

For the time that I worked with Dick Etherton, I felt that he was a huge cross for me to bear.  His attacks of gout were intensified by his absolute defiance to do anything other than eat three or more portions of red meat every day, smoke multitudes of Winston cigarettes and drink copious amounts of Miller High Life.  I did not realize at that time, though, how much pain he was in more often than not.  I look back and am grateful that he was hard on me, as that helped build my work ethic and character, but I often regret that I was so hard on him, as that just added one more pain to an area of his anatomy that was pain-free before I came into his life.  Treat your body well.