THE WAGES OF SIN

19 March 2002

I always admired William S. Gilbert (of Gilbert & Sullivan), and aspired to be like him. Of course I meant his wit and his writing skills. I did not, however, anticipate that the first trait we would share had nothing to do with creativity, but rather with pain.   I remember seeing pictures of Gilbert as he got older, leaning heavily on a cane, foot bandaged. 

Gout.

It's an old person's disease.

It's a man's disease.

What am I doing with gout?

Now, in truth, my diagnosis is a self-given one, but the signs are there. I woke up the other night with severe pain in my big toe. It hurt to have any blanket on it. Getting up and standing on it was excruciating. I managed to get to a cane that we got once when Walt broke his foot and I leaned on it heavily as I hobbled to the bathroom.

Surprisingly, as my foot hit the cold linoleum, it began to feel better. It never felt good, but it definitely felt better.

But as soon as I put the foot up, the pain would return in such a way that I knew that as soon as I tried to put the foot down again, the excruciating pain would return.

I wrote to a friend who suffers from gout. I suspected that this was what I was experiencing. He confirmed that I had all the symptoms he has. He told me to get to the doctor immediately.

Well, that's easier said than done. With my wonderful sense of timing, I find myself between doctors. I just "fired" the primary care physician to whom I had been assigned by Kaiser. It's not that we had a long and rocky relationship. He saw me exactly once. I had seen a nurse-practitioner for my gynecology check-up and she ordered the infamous tests that ultimately resulted in my diabetes diagnosis.

I made an appointment to see the doctor to have the tests read and to have him renew a prescription for an antidepressant that I had been given by the nurse practitioner. He asked why I needed an antidepressant. I explained that two dead kids might have something to do with it, he wrote the prescription and started to leave. "Aren't you going to check my lab reports?" I asked. Oh. He said. He checked them, told me my cholesterol was up, suggested diet and exercise and started to leave again. "I had blood sugars drawn--could you check that too, please?"

I explained that I had requested the fasting blood glucose test because my father had type 2 diabetes, I was nearly 60, and morbidly obese. When I said "morbidly obese," he opened my chart to check my weight.

HellOOO??? Did he REALLY have to check to see if my weight fit in the "morbidly obese" range? Or did he think I got this way by sucking in a lot of helium and that underneath all the air was really a 120 lb woman.

But yes, he agreed that I was morbidly obese and uhhhh... yes.... the numbers do... uhhhh... put me in the... uhhh... diabetic range. Spit it out, man!

You may recall that he said he'd set me up for an "Introduction to Diabetes" class, nutrition analysis, and explanation of how to use blood testing equipment. Eight months, two phone calls and three letters later, I was finally in the class. I was already unhappy about his slowness to respond.

Then my antidepressants were running out. He told me that a full course of Wellbutrin was 6 months and had written me a 6 month prescription. I spoke with both my therapist and the psychiatrist for whom I transcribe (whose specialty is medication management) and both said it was too soon for me to be off antidepressants, so I spoke with the primary care physician and he agreed to extend the prescription for another 6 months. He said he'd call in the prescription to the pharmacy.

Two days later I went to the pharmacy, and he'd forgotten to call it in. They had to call his office and asked me to return the following day to get the prescription.

This was kind of the last straw. I wrote and explained that I realized I'd been neglecting my health for years but that I had determined to take matters in hand and that I needed a physician who would work with me, and I felt that we did not have that kind of a relationship. I told him I would be seeking a different primary care physician.

That was three days before my "gout" hit. So I have a call in to the doctor I hope will be my new primary care physician, but I'm kind of in limbo. With luck, I'll be able to get in to see the new doctor and have my toe checked--and also find out why I can't lift my leg over the bar of my new bike without pain.

It's hell to get old.

If I do have gout, though, it seems highly unfair! Just when I'm doing all the right things, I get hit with punishment for all the wrong things I used to do. According to everything I've read, gout is diet-related and there are things you should not eat and things you should eat. By every list, all the no-no foods are things I no longer eat, and all the "eat me!" foods are part of my daily diet. So my body is apparently getting back at me for all the years of living on butter and sugar.

Worst is that this "gout" is affecting my exercise! I skipped the club the first day when the pain was at its worst, but I missed it so much that even with sore toe, I went in the next day. I cut my time on the treadmill and didn't go quite as fast, but I still did everything I usually do. Last night the pain was pretty bad again and I was hobbling around here leaning heavily on the cane, but I did go in to the club this morning and found that I could still work out, again at a slower speed (though for the usual 20+ minutes). I tried increasing the speed, but that started to hurt, so I figured any movement was better than nothing and just did what I could.

But I obviously need some guidance on what my limits should be and how far I can push things.