Understanding gout

Podcast transcript

INTRO
Welcome to Docs in a Pod presented by WellMed. Over the next half hour, Docs in a Pod will educate you about the health and wellness of adults everywhere. Co-host Dr. Tamika Perry and Carmenn Miles will share information to improve your health and well-being. And now here are Carmenn Miles and Dr. Tamika Perry.

CARMENN MILES
Hello and welcome to this edition of Docs in a Pod presented by WellMed. I'm Carmenn Miles alongside our co-host and guest today, Dr. Tamika Perry. If you happen to be listening to Docs in a Pod for the first time, you can catch episodes of this award winning podcast every Saturday on your favorite listening platform. As a matter of fact, Docs in a Pod is also now available on Amazon Music, audible, iHeart radio, with Spotify soon to follow. So hey, there's really no excuse. You can find us just about anywhere, including on the radio in several Texas markets. Each week we discuss health and wellness topics, especially those that impact the senior community. Our goal really is to share practical information on how we can all live healthier, happier lives, and to help us better manage some of those chronic conditions that so many of us deal with. We're super excited to have you listening in today. Thank you again for joining us. As I mentioned, our co-host and guest today is Dr. Perry.

DR. TAMIKA PERRY
Hi, how are you this morning?

CARMENN MILES
I'm doing well. Let me tell the folks a little bit about you. You can find Dr. Perry at WellMed at Redbird Square in Dallas, Texas, where she cares for her patients. She's an associate medical director at WellMed in the DFW area, as I mentioned. She oversees several large clinics in the Optum Care North Texas region. She's board certified about family medicine and osteopathic treatment. Additionally, she earned a Master of Public Health from the University at North Texas Health Science Center. She says she was inspired to enter a career in medicine to help provide quality health care to the Disenfranchised. And boy, is she fulfilling what she set out to do it WellMed at Redbird Square. She enjoys working with families and communities as a whole and building relationships with her patients. Outside of medicine, she's a proud mother, a card carrying member of Beyonce's Beehive, and she absolutely loves to travel the world. Hello again, Dr. Perry. I'm glad that we could nail you down today for this great episode that we have ahead. How the heck are you?

DR. TAMIKA PERRY
Good. How are you, Carmenn? I'm super excited about today's topic because as a little girl, I heard the term gout all the time. So, today we're going to kind of dive into it.

CARMENN MILES
I love it. Before we get into the meat of what gout is, because it is a bit of a mystery for a lot of people, let's start by first debunking some of the myths out there surrounding gout before we get into the meat and potatoes of this thing. So, first myth that I understand is out there is that only wealthy people get gout. True or false?

DR. TAMIKA PERRY
False. Gout is associated with a high consumption of meats and alcohol. At one point, that's what the wealthy could afford, right? Then the wealthy could afford to go to the doctor that would be diagnosed. But false. Anybody can get gout.

CARMENN MILES
Very good. The second myth is gout only affects the big toe.

DR. TAMIKA PERRY
Not true. That is stereotypical. That is one of the most characteristic joints of gout. That may even be a medical on a medical school test. However, it is not the only joint that gout affects.

CARMENN MILES
What about diet? A lot of people believe that your diet alone is what causes gout. True or false?

DR. TAMIKA PERRY
False. Diet alone is not the cause. It could be other medications, your health status, genetics, kidney function, etc.

CARMENN MILES
Last myth. If the pain goes away, the disease is gone.

DR. TAMIKA PERRY
That's not true. If you still have underlying kidney disease or you're taking certain medications or you're eating that same old food, they could flare up again and the disease state is still there. We're going to get into all of this.

CARMENN MILES
Very good. Thanks for debunking those myths. Let's circle back a little bit and talk about what is gout. It's a little bit of a mystery to a lot of people. Tell us a little bit about gout.

DR. TAMIKA PERRY
In my family, they call it the gout. Oh, she got the gout. It's not a death sentence, that's for sure. But let's talk about exactly what it is. Gout is a common, painful type of inflammatory arthritis. This inflammation happens in the joint space, and you're like, well, isn't that what arthritis is? It's exactly what arthritis is. Why does it happen? It happens because uric acid builds up and forms this little needle like structures. If we look under a microscope, we're going to see this little needle like structures called uric acid or urate crystals in and around the joint. It usually happens suddenly. It can happen overnight. The big toe is classic. However, it can affect ankles, knees, foot, wrist or elbows. High uric acid levels alone does not always mean a person has gout. So, we look at the totality of what's going on. Gout, again, is an inflammatory arthritis from uric acid buildup causing these urate crystals.

CARMENN MILES
Dr. Perry, let's take a moment to welcome those who may have just joined us. You're listening to the award winning Docs in a Pod presented by WellMed. Our podcast is available wherever you listen to your favorite podcasts, and we recently expanded to Amazon Music, audible, iHeart radio with Spotify soon to follow. Again, no excuse. You can find us just about anywhere, including on the radio in several Texas markets. I'm Carmenn Miles, alongside co-host and our special guest, Dr. Tamika Perry at WellMed at Redbird Square in Dallas, Texas. We're chatting about gout. What it is. We've debunked some of the myths and why it happens, and some lifestyle and treatment strategies. Dr. Perry, who's at risk when it comes to gout. Is it a genetic thing? Is it in the food that we eat? You've already kind of debunked that myth and are there certain factors that increase risk?

DR. TAMIKA PERRY
Absolutely. Genetics may play a part in it, but men are a little bit higher risk in women. Just a little bit. Women most certainly get it. People with kidney disease may be at risk for gout, because what happens is that they can't properly break down the proteins that your body would normally break down, and the byproducts of those proteins get caught up in the joint. That's where we get that uric acid build up, and that's where we get those urate crystals that we talked about earlier. So, genetics, male, most certainly kidney disease, and yes, diet does play a large part in it. So, high consumer of red meats, cheeses, wines, alcohols puts you at increased risk of gout. Most certainly anybody with a joint is susceptible to getting out.

CARMENN MILES
So, when we talk about uric acid, just to clarify that, what causes the body to produce too much uric acid?

DR. TAMIKA PERRY
It could be medications. Certain diuretics can do that. It is the inability to break down the proteins that triggers that increase of uric acid. So, you have to say, what is causing that inability of that to break down? Most often, besides genetics, are my kidneys not functioning properly or am I taking a medicine that is prohibiting that process from happening? And if that process is going on, what do I need to do to prevent it? Most common is, what can I change in my lifestyle? So, you would speak with your doctor, and the PCP should go over your entire medication list, and if you have a gouty flare, let me take you off your hydrochlorothiazide. In addition to that, I'm going to recommend that steak is not necessarily a friend. Please don't fire me and put me in the corner because I love a good steak. You might not want to consume as much alcohol. You might want to cut down on your cheeses. So, there's a whole list of our foods that we want to either decrease in consumption or eliminate from our diet.

CARMENN MILES
I have a cousin who seems to believe that pork causes flare ups for her gout situation. Is that one of the meats on the list?

DR. TAMIKA PERRY
Red meats can. That's unfortunate because bacon is really good.

CARMENN MILES
Everything in moderation, right?

DR. TAMIKA PERRY
Everything in moderation. Getting back to gout, you're talking about arthritis. So, how Is arthritis supposed to feel? It's a severe pain. In my practice, there are a few things that make the strongest, biggest, baddest men and women cry. Toothaches is one of them. Gout is the other one. Bring you to your knees type pain.

CARMENN MILES
It seems to come on suddenly in most cases that I've been close to and frequently at night. Is that accurate? Do you see that a lot in your patients?

DR. TAMIKA PERRY
Absolutely. You have to think at dinner, if you had that big, juicy steak and a glass of red wine, that process is going to be working overnight. Typically, we don't have that for breakfast. Sometimes we may have it for lunch, and then you wake up and like, what's wrong with my foot? It's so bad that sometimes even the weight of the bed sheet on the foot can send you screaming. It's extremely, extremely painful. Untreated gout can lead to more frequent attacks, joint damage and lumps around the joint space called toe phi. So, if you've ever seen someone and their hands have these little nodules around the joint space or their wrist or their elbows, elbows are notorious for it, those are called toe phi. As a person who has really, really bad gout.

CARMENN MILES
What are some of the other common symptoms? You mentioned the intense pain.

DR. TAMIKA PERRY
Swelling, redness, warmth of the joint space. It's also important for us to just digress for a little bit. Gout is not the only type of arthritis. So, there's osteoarthritis which is wear and tear arthritis. You may get some of the same symptoms. Gout is just above and beyond the call of duty. The osteoarthritis is going to cause the toe phi. The osteoarthritis wouldn't be isolated to just the big toe. So, osteoarthritis is wear and tear arthritis like your knees or your hips. There's lupus arthritis where that's an autoimmune disorder. There's infectious arthritis. So, you can get arthritis what's called a mono articular in one joint like chlamydia or gonorrhea can cause an infectious arthritis. They all may present the same, and that goes back to if something is wrong, go see your doctor so we know in which direction to point the treatment.

CARMENN MILES
Absolutely. Let's take just a quick break, but please, everyone stay with us as we continue this great health care discussion on gout. You're listening to Docs in a Pod presented by, WellMed. We'll be right back.

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CARMENN MILES
We're back on Docs in a Pod. I'm your host, Carmenn Miles, along with our resident co-host and guest today, Dr. Tamika Perry. We're chatting about gout, an inflammatory and painful form of arthritis. We've gotten into the meat of things. We know what gout is now. Dr. Perry, are there some good medications or certain medications that you typically lean on when you have a patient with gout that's struggling with the pain associated with the disease?

DR. TAMIKA PERRY
Oh, absolutely. One of the first medicines was a medicine called allopurinol. What allopurinol does is that it helps to reduce your uric acid levels. Remember, this is the trigger for the pain. So, some patients are on allopurinol as a part of their regular medication regimen to help prevent the flares. In more recent history in the last 10 or 15 years, there's been newer medicines like Uloric, and it helps to prevent the uric acid from building up inside of the joint space. Now, what happens is, is that when you first tried to take these medications, you have to watch out for flares, because particularly Uloric will push all the uric acid out of the joint space and you're like, whoa, what's happened? So, in the meantime, you may have to take a medicine that acutely stops the inflammation. Those medicines are like colchicine, NSAIDs like ibuprofen, indomethacin. If your body can't handle those NSAIDs, and just as a reminder, NSAIDs stands for non-steroidal anti-inflammatory drugs. Now, those aren't necessarily indicated for every person. If you're a person with acid reflux, you might not want to take sets because they can evoke acid reflux, can potentially cause an ulcer with repeated use. So once again, that's why you're going to consult your physician and say for breakthrough gout pain while I'm on that allopurinol is indomethacin right for me? If you have chronic kidney disease, NSAIDs are not necessarily for you because NSAIDs, even though they do a great job of lowering inflammation in your body, they also drag down kidney function. We need those. They are very important in our body. So, we do not want to do anything to hinder the function of the kidneys. So, your option then may be a low dose steroid because remember, steroids are the ultimate anti-inflammatory drugs. They're not bad for your kidneys. We're not advocating you take the ones like bodybuilders would take. Just low dose steroids to calm down that gouty flare. Now, allopurinol and Uloric are not without side effects, right? Neither are the other drugs. Colchicine can cause diarrhea in some individuals. Allopurinol. You want to make sure that a severe allergic reaction called Stevens Johnson reaction does not happen. It's rare, but if you get a rash afterwards, you definitely want to let your provider know. Like we alluded to earlier with Uloric, within that first month, in six weeks, you could have gouty flares. Not that the medicine is making it worse, itÕs pushing out all that uric acid from your body. So, during that time you may have to be on an NSAID or a low dose steroid. But these are very, very good options. Our best options are prevention, and prevention is looking at your family history. You really can't change your family history, but you're aware of it. Look at your medication list. Is one of these medicines on my list causing my gouty flare? Am I on a diuretic? You want to look at diet. We talk about diet and what is more likely to cause a gouty flare. Organ meats like liver or kidney if you're into organ meats. Did your mom ever make liver and onions at home? It smells no good cooking, but I was like, I'm good, mom. I'm going to drink water tonight.

CARMENN MILES
Just this week, my mother went to Luby's to get liver and onions, and she was so upset that they were out. I don't understand it. I can't with the organ meats.

DR. TAMIKA PERRY
Yeah, I'm not an organ girl. So, in moderation, like you said, or limit beer and liquor. Limit overall alcohol. Please, no one fire me or stop listening. Limit beer or liquor. Large portions of red meat. So once again, we talked about steak and other red meats earlier. We really want to try to cut down those. High purine, which is an amino acid. Seafoods like anchovies, mussels, scallops, sardines. People say, well, I'm going to stop eating my steak, but I'm going to have a bunch of scallops and anchovies. Not necessarily. You might want to have some light fish instead of salmon. Sugar sweetened drinks and high fructose corn syrup. I know it gets blamed for everything, but it's true. So, we want to definitely limit these. Crash diets and dehydration can lead to gouty flares. We really want a balanced DASH or Mediterranean style diet. DASH diet stands for Dietary Approaches to Stop Hypertension. We could do a no show on those, but basically, itÕs low sodium, lean meat, fresh fruits and vegetables type diet. Or a mediterranean style diet where meats are kind of a garnish. We're talking about good oils like olive oils, leafy green vegetables like spinach, garlic, that type of diet. Plant based proteins like beans or lentils. So, you might want to try a lion's mane steak instead of a regular filet mignon. And once again, no one cancel me. I'm just a messenger. Fruits and reasonable portions. Vegetables, whole grains, low fat or nondairy fat and water or unsweetened beverages. Your kidneys love water. Your joints love water. Your lungs love water. Your brain, your heart. Your body loves water. Not water that's flavored like margarita, like mine often is. Your body works.

CARMENN MILES
I'm just thinking about my dinner at PapadeauxÕs last night.

DR. TAMIKA PERRY
I went to PapadeauxÕs last night, too. I do not have a gout friendly meal.

CARMENN MILES
Well, the meal, not so much. But the cocktails, yeah. I drank my water, though.

DR. TAMIKA PERRY
Yes. Well, congratulations. always like to give patients tidbits. What can we do without putting another pill in your body or less of a pill in your body? Like a lower dose or just maybe subtract one. What can we do from a simple perspective when we're choosing foods? You want half of your plate to be those non-starchy vegetables like leafy greens. You want a fourth of your plate to be whole grain, high fiber starch, and then keep red meat portions modest. I would even say, not only do we keep the portions modest, but limit also how often we're having those portions. Most often choose water to drink. So, tell the waiter, yes, all I want is water. I'm good with that. YouÕre still going to get your tip, but I would just like water. Then you want to stay hydrated. Unless we have put as your clinician fluid restrictions on you because of renal disease or cardiac disease. So, for the most part, a good gauge of how hydrated we should be. Your urine really should be clear, faint yellow, basically almost looks like water with virtually no smell. Once your urine looks like that you are, you're on your game. You are drinking enough water for your body. People always want a fancy equation and there are fancy equations out there but listen to your body. That's what your body's telling you. So, unless you have water restrictions, always drink enough water until your urine starts to look like that on a daily basis. In the morning it's going to be darker because it's concentrated from overnight, but sometime throughout that day you should achieve that goal and that should be your goal every day. If weight loss is appropriate, aim for gradual, not rapid weight loss. So, those lifestyle changes, that's a simple, friendly way to say how can I prevent these gouty flares from going up. Maybe I can go from dose A on my allopurinol to dose B which is lower with these simple changes. Or maybe we can even eliminate it and just treat with colchicine or a little indomethacin when it flares up when we've made these changes.

CARMENN MILES
Very good. I'm curious if we have listeners today who are sitting there thinking, gosh, maybe I do have a gout flare up and they're nervous about seeing their doctor. A blood test measures your uric acid levels, but just because you have an elevated level of uric acid does that mean you have gout?

DR. TAMIKA PERRY
That doesn't necessarily mean you have gout. The best way is to really take fluid from that joint space and look for the uric acid crystals. That's like 100% sensitivity and specificity, meaning, if I see those crystals, it is what it is. But that process isnÕt the most comfortable, and I'm not in the business to have patients kick me while I'm trying to take crystals out of their big toe that's really hurting them.

CARMENN MILES
For those listeners who are afraid of needles, are there other options?

DR. TAMIKA PERRY
Well, it's really a clinical diagnosis. It's kind of like if you see a person and they're a female in their childbearing years and they have a belly that's hard and they have been having sexual relations, you can you don't need a fancy degree to say you're pregnant, right?

CARMENN MILES
Sure.

DR. TAMIKA PERRY
You can almost kind of do gout the same way. So, if you're a gentleman who's 50 plus, and this can certainly happen to anyone, this is just a clinical scenario, you enjoy a cocktail and or beer in the evenings. You like steak. Your big toe is warm, hot and swollen and your dad had gout. Guess what? It's the gout. I don't need to stick a needle inside of that joint space. I know that because once I start you on allopurinol, you'll be like, oh, that only happens now once a year. That used to happen once a month. So, if it wasn't gout, that mechanism wouldn't necessarily work. So, you don't need to necessarily go through that torture of that needle. It is a clinical diagnosis. Now, I do want people to realize, like we talked about earlier, that genes, kidney functions, medications, body weight and other health conditions all influence uric acid. So, even if you think you have gout and you've treated at home with over-the-counter ibuprofen, I don't want you to necessarily think, well, I stopped eating steak, why is it flaring up again? One, you may have missed the diagnosis. Two, I need you to go see your doctor so we can tease out any other causes of your gout so we know exactly how to guide you so you don't have these flares. It really can be debilitating.

CARMENN MILES
Absolutely. Go see your doctor.

DR. TAMIKA PERRY
Yes.

CARMENN MILES
Dr. Tamika Perry, it's been a great conversation with you. Again, you can find a Dr. Perry at WellMed at Redbird Square in the great city of Dallas, Texas. Thank you for your time, Dr. Perry, and for so willingly sharing your expertise. Thank you to those who are listening. Listen, gout is more than an occasional joint pain. It's painful, common, and often misunderstood. It requires both symptom control and long term prevention. So, if you believe you or a family member or friend may have gout, go see your doctor. It's treatable. Get the care you need to alleviate some of that pain and start thriving again. Listeners, don't be a stranger. Subscribe to this podcast so you never miss an episode. If today's show helped you, sharing is caring. Tell your friends and family where to find us every Saturday on any podcast listening platform, now including Amazon Music, audible, iHeart radio and Spotify. You can also catch us on the radio in several Texas markets. You're listening to the award winning Docs in a Pod presented by WellMed. Until next time, stay well.

OUTRO
Executive producer for Docs in a Pod is Dan Calderon. The producer is Cherese Pendleton. Thank you for listening to Docs in a Pod presented by WellMed. Be sure and listen next week to Docs in a Pod presented by WellMed.

DISCLAIMER
This transcript is generated using a podcast editing tool; there may be small differences between this transcript and the recorded audio content.

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