Health Challenges for Riders

I suspect it's pretty rare, if not impossible, to be a human being in this world and not have your own challenges and physical issues. I would be shocked if I didn't know an equestrian in particular who didn't have a nagging something - bad back, bad knees, lingering concussion syndrome, general arthritis, you name it, whether from a bad fall or just wear and tear. This has been much on my mind this winter: many of the workers at my barn have been injured, ill, or otherwise out of commission physically.

(As the barn manager said, and I agreed wholeheartedly, better us than the horses. Then I had a moment of pause and considered my priorities and realized I still felt that way and...I need help.)

I have a standard assortment - some arthritis in my hands, a bum knee (why I don't ski anymore; I partially tore the ACL and decided I'd rather wreck my body riding than skiing), a lower back that's less than optimal after a bad fall about 5 years ago.

My special snowflake health challenge? Gout.

Yes, you read that right. The "rich man's disease," the thing that old, fat, villains in melodramatic 19th century novels suffer from.

So what is gout? It's basically a form of arthritis, in that it attacks the body's joints and causes pain, limited mobility, and eventually, damage.

Gout is caused by an increase in the levels of uric acid in the body, something which most people process without difficulty. In a certain number of people, however, those levels keep rising, and the body can't metabolize the uric acid. The uric acid migrates to joints and forms little spiky crystals.

The most common presentation by far is for those crystals to collect in the joint at the base of the big toe of the right foot. It's almost always the first place you see an attack. These attacks are extremely painful, as you might guess by the image of the spikes above.

I had my first gout attack when I was 23. I thought I had broken my toe. I kept wracking my memory: Had I stubbed my foot? Had Tristan stepped on my foot? Had I bent it funny? What the heck?

I hobbled around for about two weeks, and it got progressively worse. In the last few days, I progressed to even more classic gout signs. The joint grew red and inflamed. I couldn't even bear the weight of the sheets in my bed on it, and slept with it propped up on a pillow in open air. I finally went to the doctor. Within about 10 minutes, he had diagnosed me with gout.

The incidence rate of gout in healthy, pre-menopausal, never-pregnant women is a fraction of a fraction of a percent. As it turns out, I completely lost the genetic lottery: my grandfather had gout, and my uncle has gout as well. I inherited the condition (much like my migraines) and it simply waited for the right trigger to appear.

Gout is chronic, and I will spend the rest of my life managing the condition. Primarily, this means I watch my diet carefully. Red wine is right out, as is seafood. I can only eat red meat or drink alcohol in very careful moderation. I discovered over the years that for me, spinach and turkey are also triggers, which is really too bad. I can eat them both, but not much, and not for more than one meal every few weeks. Anything sweetened with high-fructose corn syrup is a no-go, so I examine juice labels in particular very carefully - actually, 95% of what I drink is water, because it's safest and because it can help "flush" stuff out of my system. I get my blood levels checked for uric acid at each annual checkup to make sure I'm managing effectively.

Over the years, I've had attacks mostly in my feet, but sometimes in my knees, and once in my right pinky. (That was weird.) I think anyone who lives with a chronic health condition gets to know it on an intimate level. I know when an attack is imminent, and sometimes I can ease them away with diet. Sometimes my foot starts aching and I am completely stumped as to why. When it's bad enough, I have a prescription anti-inflammatory that I take to help my body through bad attacks - it's basically palliative, reducing the inflammation in the joint so that the body can gain time to slowly process the uric acid crystals and get itself back on track. There is longterm daily medication, but I hope never to have to use it.

I decided to write this because this week, my right big toe started up again, in both the ball joint and the toe joint. They're not bad: just a dull ache, a spiky reminder when I walk. It hasn't been this bad in months, so I may be falling back on the drugs for a few days.

Luckily, apart from really bad attacks, it doesn't impact my equestrian activities too much. I might walk a little more slowly, and sometimes I might ride without stirrups to take pressure off my foot, But it's not like running or playing soccer or another hobby that actively engages my feet. So I got pretty lucky in that regard.

So there's your primer! I'd be happy to answer any questions.