“I think I broke my toe.”
My wife turned away from the bathroom mirror, put down her flat iron, and looked at me, equal parts concerned and unsurprised. “How did you hurt it?”
“I don’t remember. Buuuutt, pretty sure it’s broken.”
Used to my highly participatory approach to life, she went back to straightening her hair.
“Oh. Well, I’m very sorry it hurts. Maybe put some ice on it? I know it’s silly for me to even suggest it, but maybe go to urgent care?”
Pain and I go way back. I compound fractured my tibia in high school, then shattered my elbow falling from a ladder in my 20s. I’ve had extensive orthodontic surgery, and the same girl broke my heart twice. I’ve got an alarming pain tolerance, honed by years of grinding against the whetstone of life.
But, despite my familiarity, I’d never experienced pain like this. It felt like a burning red ember, pulsating and angry, had somehow wedged inside my toe joint.
Foot propped up on the ottoman, I cracked a beer. Two pages of Google search results and 20 minutes later I decided I either had bone cancer, extreme bunions, osteoporosis, or all of the above. I tried to rest some ice on the inflamed toe, but the weight of the bag proved too much. The pain had come on so quickly, I was convinced I’d dropped something on it, or badly stubbed it, but could not identify when or how.
Having taken half of my wife’s advice, I figured urgent care could wait until morning.
It could not wait until morning.
Around 3 a.m., I woke up to an even more extreme pain. At 34 you don’t expect your body to surprise you so viscerally, but there I was, in the pitch black morning, near tears with some unknown ailment.
The shimmy of the blanket across my skin as I got out of bed sent new needles through my foot. The air from the oscillating fan passed over my toe, and I nearly fell over. A slight breeze was enough to bring down a full-grown man. Brought low, by a toe.
Unable to do much else, I took some Advil and literally shivered in pain until morning. Getting even a slipper onto my foot required several loud “fucks.” I could barely push the brake pedal on my car. I hobbled into the urgent care waiting room. As I waited for them to call my name, I assumed the worst: gangrene, amputation, flesh-eating virus.
The nurse took my vitals. Despite the pain, I felt relatively normal. I hadn’t had any serious health issues in my life. My blood pressure came back normal. As far as they could tell, I was fine. But I was very not fine, and I did my best to articulate such.
The doctor finally came in, assessed the hot-red mess at the end of my foot, and asked: “Do you eat a lot of seafood?”
“Yes.”
“Do you drink a lot of beer?”
“Not a lot.” (Yes I did.)
“Do you eat red meat?”
“Yes.”
“Well, it looks like gout to me.”
Gout. It’s a word I could only attribute loosely to Shakespeare, or some other piece of faded antiquity. The doctor might as well have said I had scurvy or unbalanced humours. She gave me some Prednisone, told me to lay off the “trigger foods,” and see a podiatrist.
After the steroids hit my system, I felt amazingly better, enough so that I went back to work (at a brewery, mind you) and figured that was that.
That was, in fact, not that.
People might know gout as “the King’s Disease,” an affliction of the hedonistic and wealthy, those with poor diets or decadent appetites. But other than drinking quite a lot of beer, I’m far from the poster child for poor health. I exercise regularly, eat lots of fruits and vegetables, and hydrate like I’m training for a marathon. But gout, the buildup of crystallised uric acid in the body, does not discriminate.
Living with gout and working for a beer company felt like harbouring a terrible secret. The diagnosis was downright embarrassing. In the vernacular, gout was caused by being a disgusting glutton, or from abusing alcohol. For a while, I didn’t tell my coworkers, and was afraid to tell my wife. A random injury? Could happen to anyone. Gout? It felt self-inflicted, and I presumed everyone would think of me as some binge-eating alcoholic.
I tried to make up excuses for two more flares, but after that, I couldn’t hide it anymore. I came clean to my friends, and accepted that perhaps I was eating too much crab and drinking too much beer. After doing a ton of reading, I realised that gout was more common than I knew, with 1 in every 25 Americans suffering from what is now the most common form of inflammatory arthritis in the country.
A person afflicted with gout has trouble naturally ridding the body of uric acid. Once enough builds up in the system, it finds its way to a singular place—usually extremities, like big toes—and settles. The uric acid crystallizes, which causes an immune-response, which in turn, makes you seriously consider retrieving a hacksaw from the garage to end the pain.
While obesity and advanced age are typically associated with the onset, it can happen to anyone whose renal system isn’t up to snuff. Purines, which break down into uric acid, are present in almost all foods, but especially organ meats, shellfish, and beer (thanks to its yeast). In theory, even a teetotaling vegan could experience a gout flare, but those with a propensity for the more carnivorous side of life skew the odds toward the house. There’s also a genetic component, which means I was doubly doomed by both dad and diet.
Health issues, while scary, force introspection. It’s easy to fall into a familiar routine, eating and drinking with reckless abandon. In my 20s, I mindlessly put down Yuenglings doing yard work; beer was fun and fuel and frivolity, an accouterment to life that couldn’t possibly bring me down. But nothing golden can stay. When your body uncharacteristically fails and you find yourself missing work or unable to spend time with your kids, you can’t help but reexamine your habits.
Working in the beer industry, I’d fallen into the habit of thoughtlessly cycling through pints. Part social, part habitual, all contributing to a chronic condition that, uncontested, could lead to serious and long-lasting consequences. At one point in the twilight youth of my beer drinking, I examined nearly every beer I drank—analysing, cataloging, discriminating—but over 10 years, it became robotic, rote consumption.
Gout felt like the vanguard to more insidious conditions, an early warning flag that perhaps I needed to put my body before my brain and prioritise my long-term health over my short-term fun. If I was already experiencing issues from overconsumption, was my liver next? My heart? Something I couldn’t simply take a pill for? In moments like this you think outside yourself, instead imagining your daughter’s future, your wife’s, and how you’ll be a part of it, and in what physical condition.
My dad drank a lot, and he also had gout. While leukemia was the ultimate cause, his drinking likely contributed something to his young death at 61. The weight of not having him in my life drags behind me like an emotional anchor, and as I watch my daughter get older, I’m terrified she could feel the same. The selfish choice of drinking a beer for me now stands at odds with the selfless choice of not drinking it for her, pitting old me against new me in a cage match for existential dominance.
My podiatrist put me on Allopurinol, a medication that would help flush uric acid out of my system. It’s a godsend, and since I started taking it, I haven’t had a flare. But I’m taking the disease seriously; in the two years since my initial diagnosis, I’ve done my best to fight years of compulsive habits, eliminating certain categories of food entirely (seafood) and cutting back heavily on alcohol. With these changes to my diet and a newfound consciousness of what (and how much) I’m putting into my body, the medications are probably a formality, but I wouldn’t risk feeling that kind of pain again.
I miss crab the most. Gout sufferers quickly identify their specific triggers, and Maryland’s favourite shellfish is public enemy number one. I’ve found that I can still drink beer in moderation, but gone are the days of all-night sessions at the pub, lest I anger the arthritis gods. It’s not nearly a bad thing. While the pain was excruciating, the involuntary reminder to slow down has provided me with a chance to reset and reflect, to savour life rather than gulp it down. I’m far from saying gout was good for me, but in perspective, I’m glad I only had to suffer through the alarm, and not the whole house burning down.