Friday, March 7, 2014

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.


  1. My uncle had that, it's really frustrating! Sorry to hear it bothers you :(

    1. It really can be! Luckily, with modern medicine, it is a very manageable condition for me.

  2. Same here, my uncle had gout too. We weren't especially close, but it sounded pretty rough.

    (Heh. I've never learned to ski/snowboard; I'm saving my knees for the horse sports.)

    1. I skiied for a few years - I went to college in Vermont, and my school owned a ski slope, so it was just What We Did in the winter. But no more. I'd rather curl up with a book and hot chocolate in the base lodge.

  3. No red wine! How do you live?!

    In all seriousness, though. It's great that you're so proactive about your health issues. These sorts of conditions can be so easy to disregard. Good luck!

    1. Do you know, I don't really like the taste of it to begin with, so it worked out ok! I am a sweet white wine drinker when I do go for wine at all, and even that is rare.

      I try to be pro-active about it but ultimately I am so far behind compared to how neurotically I would be monitoring my horse... :P

  4. Wow, that's a different one! At least it seems to be manageable. Thanks for sharing. :)

    PS Sounds terrible, but I love the little drawing of the devil gnawing on the big toe..

    1. For me, it is - so far I've been lucky.

      That drawing is so nifty. It accompanies most explanations of gout and is a fairly accurate representation of what it feels like. ;)

  5. Replies
    1. A friend of mine had some attacks while pregnant, which is apparently not uncommon. It's one of those hidden things that people don't hear much about unless they know someone!

  6. Ooohhh goodness. =( I hate it for you! But I'm thankful its mostly manageable! Sounds like you trend toward a vegan-esque diet to manage?

    You may find the book, The China Study by T. Colin Campbell interesting as far as diet and nutrition and their affects on human health. I was blown away by it. The number of studies cited in the book kicked out all the skepticism I tried to stand on as I read it. Its harder to argue when study after study after study supports the same hypothesis - even when the study wasn't designed to try to support it!


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