Gout and the sleeve

This has not been a good day.   I got woke up this morning by a dull ache in both knees.

A little background.  I have suffered from gout since about age 18 and I am currently 51.  For the last 2 years, I have had it pretty well under control with my PCP and quit seeing my rheumatologist.    My surgery was in late April and I was concerned about gout.  Drastic weight loss can trigger a gout attack as uric acid is stored in fat.  To address the issue, I made an appointment in June with my rheumatologist so I would be on his radar.  Sure enough a week later I find out my uric acid levels are elevated so he upped my meds.

Subsequent to seeing him today, I started my workout routine.  Where before I had slowed down to 2-3 lbs lost per week, in the last 3 weeks, I lost 15lbs.  My doc believes that weight loss combined with the previous loss triggered the attack.  Now, I have had worse attacks located in a single joint but for the first time, this attack hit both knees, my left elbow and the toes on my right foot.  The elbow and foot pain level was about a 4 while the knees where pushing 7-8.

As stated before, I was woke up by a dull pain.  Well, during the day, that pain increased considerably and my knees were getting stiff.  Having it in both knees must it considerably more difficult to walk.

As part of warding off a gout attack, one of the meds you take is colchicine.  The directions say to take 2 tabs and then one per hour until the first sign of sickness.(Nausea, the runs or full blown chunks).  Lovely, the medicine that might help, can make you very ill.  But a nausea et al is diffinitely better than a full blow attack.  Alas, the colchicine did not work and I found myself in a full blow gout flare in multiple joints.

Now, the reason for this post is two fold.  Share a little of my misery and to serve as a warning to anyone who has ever had gout in their lives and are going to have WLS.  The importance of hooking back up with the rheumatologist was that he is more likely able to treat the acute flares.  Most MDs, while they can prescribe the medicine, are reluctant to give you cortisone shots in the affected joints.  I called his office at 1:15 and I was in his office by 3:15.  Luckily he understands how painful these attacks can be so he does everything possible to get you in.   I ended up with a shot in both knees and those should cover the other joints.  Part of the treatment is to drain any fluid from the joints.  The right knee was the only one with a substantial amount and he pulled out 15cc.  He held it up to me and said, "That is proof this was not imaginary pain."  

He has changed my meds and hopefully that will cover the problem.  But, I am so glad I saw him in June as he probably would not have seen me today.  (it had been 2 years since I last saw him).

A side note, I have a prescription for hydrocodone and in the past, I have always taken 2 for these type of attacks.  I am finding out 1/2 a tab is sufficient.  Strangely, hydrocodone did not hit me that hard post surgery.  I also told the doc, that this gout attack was way more painful then any of the surgery pain I had.

So to reiterate, if you have ever suffered from gout and are due for WLS, get a rheumatologist and monitor your uric acid levels closely.  BTW, rheumatologists can be somewhat difficult to get into especially if you are a new patient.

Thanks so much for your post about gout. I had my sleeve surgery in April and also had an attack the week before surgery and now three months after. Thank God mind have not been as severe as yours as meds seem to take care of it, but as low as intake of food I'm having I was wondering why I was having an attack now. Thanks for explaining.

You also need to be more vigilant with your liquids as water helps flush the uric acid.

I had a couple of pretty good gout attack shortly after surgery.  Since then I've stopped taking allopurinol (at about 5-6 months out as I recall) and the incidents really stopped.  In the last couple of years I've probably had 3 or 4 very mild attacks that were resolved with advil/tylenol in less than a day.  I used to have to take lodine or other steroids and the attacks and after effects would last for a week.  It doesn't always go away but sometimes it does get better.  Hang in there!  Lots of fluid and try to avoid injury to your joints.  Any swelling can be a starter to crystals in my experience.