Is Your Doctor Killing Your Health?
Posted by GoutPal in Better Gout Treament, Diagnosing Gout, Gout Diet, tags: gout diagnosis, gout symptoms, purines, uric acid testI’ve just seen some more out-of-date medical advice on a doctor’s website, and it’s making me seethe.
Everybody trusts these guys to give sound, current health advice, but what do they churn out?
Disproved speculation that at best does no good.
At worst, it condemns you to years of pain and discomfort. Years of low quality of life.
I’m tempted to name the offending site, but that would only single out one miscreant among the many – online and in their consulting rooms.
Instead, I’ll analyze a few quotes, and allow the diligent among you to guess where the site is by virtue of GoutPal’s Worldwide Search Engine.
The Symptoms
Our doctor starts with:
severe pain in the big toe…condition affects the age group 30 to 50 years old
So it could be gout. But what about 48% of gout sufferers who don’t get pain in the big toe?
What about the small number of people under 30 and the massive number of people over 50 who get gout? Will they not even be considered for a gout diagnosis?
The Diagnosis
Fatal Flaw #1.
To be sure therefore if your joint pains are due to this disease [gout], a simple blood test called uric acid can easily be determined in any lab
All that a uric acid blood test will tell you is how much uric acid is in your blood.
If it’s high, it suggests that you are at risk of uric acid crystals forming in your blood which may induce a gout attack in the near future (a bad thing).
If it is not high, and you are having a gout attack, it suggests that you might be suffering from a reaction to new uric acid crystals that have formed recently (a bad thing). Or you might be suffering from a reaction to old uric acid crystals dissolving (a good thing).
If it is normal, it tells you that your uric acid level is normal (a waste-of-time thing, but reassuring to some people who don’t understand gout).
A uric acid blood test, though useful as part of a program to reduce uric acid, will not tell you if you have gout.
Because a uric acid test is inconclusive, our inexperienced doctor will prolong the investigation, and repeat the inconclusive test, until he can conclude, rightly or wrongly, that you have, or do not have gout.
Find the last paragraph incomprehensible? At least it’s not in Latin.
Get a rheumatologist to perform a proper test for gout. That way, if you have gout, you can get treated fast. And if you haven’t, you won’t waste your time and money on gout cures when you have pseudogout, septic arthritis, bursitis, or one of the other conditions commonly misdiagnosed as gout (presumably as a result of an inconclusive uric acid test)
Our doctor should learn that:
A uric acid test can play an important role in managing the correct treatment of gout as part of a urate lowering strategy, but plays little or no part in the diagnosis of gout.
Let us assume that, by chance, we have a correct diagnosis of gout. Surely our doctor can prescribe the right treatment.
The Treatment
Fatal Flaw #2
Taking simple steps starting with our diet can go a long way in improving our health
I’m not sure it’s a starting point, but anyway, let’s consider the doctor’s gout diet advice?
NO NO if You Have GOUT or High Uric Acid:
* The NUMBER ONE on my list is ALCOHOL!!!!
* Anchovies
* Gravies
* Herring, Sardines
* Mussels or Tahong
* Internal Organs like liver, kidney
* Dinuguan, Chicharon Bulaklak
* Mackerel
* Patis and Soya Products
* Bacon and scallopsUse in Moderation:
* Crabs, Oysters, Shrimps, and eel
* Poultry and Meat [including] soup and broth
* Oatmeal
* Certain Veggies like asparagus, spinach, mushroom and cauliflower
* Legumes like beans or lentils
Let’s leave the alcohol for another discussion – do doctors always advise less alcohol so there is more for themselves?
The doctor’s recommended gout “diet” is the list of high/moderate purines in food that’s been kicking around since scientists discovered that uric acid comes from a certain type of protein in our bodies called purines. The key here is “in our bodies”, not in our mouths. Uric acid comes from cells in our bodies, not in our food. Whilst it is true that an imbalanced diet, rich in purines, can raise uric acid levels, this is true of many imbalanced diets. Including starvation.
This type of food advice is dangerous nonsense. At best, gout patients will stumble into a healthier diet by considering what they eat. At worst, as frequently happens, gout patients believe gout management is simply a food issue, and so they delay proper treatment.
Our doctor should learn that:
Where gout patients are overweight, but excrete uric acid normally through urine, gradual weight loss can reduce the amount of uric acid produced by the body. Patients who under-excrete uric acid will gain little benefit for gout from dietary changes and must focus first on medication to promote uric acid excretion.
The Consequences
As the above is published on a fairly prominent website, it attracts questions from many gout sufferers and their carers. These questions often give scant information, then are met with generalizations that could mean anything. Example:
[edited for clarity/spelling]
I’m 44 yrs old, 5′ 8″, 188 lbs. I first experienced pain in my left ankle 4 months ago w/c was diagnosed I have hyperuricemia. The pain went without medication. Now my left knee & its surrounding areas ached which sometimes makes walking difficult. What medicines should i take to lessen the uric acid?
My response would be something along the lines of:
I’m not a doctor, and can’t give specific medical advice, but my observations are:
- You are 9lbs away from clinical obesity, and excess weight is a significant factor for hyperuricemia.
- Hyperuricemia simply means higher than normal uric acid levels, though you haven’t said what your levels are, so I cannot confirm that diagnosis.
- High uric acid levels are a common cause of, but do not always result in, gout. You need to have fluid from the affected joint(s) tested to see if you have gout, and to rule out other diseases.
- After you have had the joint fluid test (arthrocentesis), consult your doctor for advice on which uric acid medication, or changes in lifestyle, suit you. He will carry out kidney function and other tests, and review your medical history and other medications. He will discuss this information with you to ensure you get the correct medication to suit your circumstances.
Instead, we get, from a doctor who is presumably qualified to give medical advice:
If the problem is really due to high uric acid and you have an inflammed joint, a specialist like a rheumatologist will do certain tests including getting a sample of your inflammed joint and to look at the fluid if they indeed contain uric acid crystals. Drugs like NSAID e.g ibuprofen, and Colchicine can reduce inflammation; But you may need drugs to reduce the production of uric acid like Allopurinol Talk to your doctor about these drugs.
I think “You need a rheumatologist as I’m not really up to explaining the complexities of gout” is a bit poor for an MD.
It is sad that ordinary people feel that they cannot trust their own doctor and seek information on the Internet. Perhaps the doctors busy lives mean they cannot explain conditions and treatments well enough to give patients the confidence to follow their advice.
It’s sadder still, that where doctors do have a platform on the Internet, and thus the resources to fully explain causes and effects of complex conditions like gout, they still fail to measure up.
Come on doctors. Raise your game.
Take a little extra care to keep up-to-date.
Take a little more time to check latest research.
Take a little more notice of all the needs of your patients.
Please stop killing our health.
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And for those of you who think this is just another rant from GoutPal that has nothing to do with the real world, read the terrible story of Chris, the disgruntled gout sufferer.
In fairness to the family physician, gout is only one of the many conditions they deal with. After my last attack three months ago, I have spent a lot (and I mean a lot) of time on the internet trying to understand gout, hyperuricemia, monosodium urate crystals, sleep apnea, etc., etc. etc. I’ve been studying medical books and made I don’t know how many searches of the web on obscure medical terms. Only someone who has a gout problem can understand how motivated it makes you! God have mercy on those poor souls who have progressed to tophaceous gout and suffered serious joint damage! Imagine how frustrated they are with the medical profession after so many years! I have learned a lot but there are still a lot of questions that I still have. The feeling I get from physicians is that I am extremely presumptious to ask. I think that I have arrived at the right questions. The trouble is that I am not sure that anyone has the right answers. I’m pretty sure that the average family physician doesn’t know.
Whilst I see your point about the average family doctor, I certainly cannot forgive a doctor who publishes the type of drivel I saw.
The duty of care to patients does not disappear just because you cannot see the patient you are writing for.
If these so-called professionals spent a fraction of their extremely well-paid time doing a fraction of the research that you have done then my mailbag would not be overflowing with tales of gout patients who have suffered years of neglect.
Point taken. When you set yourself up as an expert as some of these guys have done, you need to really be able to deliver. If you don’t know the answers, don’t give an answer. Some of these souls have suffered with this disease for decades and they deserve better. I believe the answer is there but scattered among the scientific studies that have been done. What is needed is someone who is very knowledgeable about the body and organic chemistry and who can write so people can understand them. In addition, that person would have to have the money to buy the most recent studies from the different subscriber services. It is certainly not me. No matter how hard I try, I cannot penetrate the “medicalese” and the “organic chemistryese” to get to it. If the person who writes up the research is a good writer, I can understand maybe twenty percent. Fortunately, the conclusions are better written than the rest of it. Even if you could find someone who could do this, it would still need to be published in one of the better read medical journals. Maybe, just maybe, it might help some people. While I really like my family physician, I can’t picture the day that I will walk into his office and hear him say something like “Brian, I have wonderful news! We know what causes gout and hyperuricemia! We can cure you!”. Not very likely, is it? The best that you can hope for is “There is a new medication that will control the gout flareups better.”
Well said.
In all fairness to the treating physician, if you are concerned with your diagnosis (or lack thereof), seek a second opinion. Most physicians have good intentions and would welcome this if you ask for it.
For a layperson, I have a pretty good idea of the issues involved. I have pretty much done all that I can do to get my serum urate level down and to keep my serum ph level up to keep the crystals from forming. I have lost all the weight I can. I know the foods to eat and not eat. I know the herbs and supplements that help. So far, I haven’t gone on medication. I am not so much afraid of the acute attacks but I am experiencing minimal joint pain in joints I have not experienced before. I feel like I am about 85 to 90% of where I need to be. If I could get that extra ten to fifteen percent, I would be alright. In fact, all of the changes that I have made to avoid gout will help with my overall health.
There are three areas that I think I could benefit from but they are not part of the standard treatment program. Checking the body iron load and if necessary lowering it. Lowering the heavy metals in my body to increase the uric acid excreted from the kidneys. Eliminating sleep breathing disorders to keep my ph levels higher while I sleep to reduce the formation of crystals. I think there is another potential there to solve my problems. Some of this, I might be able to do on my own but some will require a physician’s participation. Since it is not part of any standard treatment, the physician would have to justify it to my health insurance provider. The problem is to find the right physician.
GPs are clueless.