Charles couldn't believe the intensity of the pain – and he had been shot during a tour in Iraq with the Marines.
"I was lying in my sleeper and my big toe just went on fire. It was like nothing I had ever experienced. I thought I was going to pass out from the pain,” Charles, a long haul truck driver who asked that his real name not be used, explained. “My big toe was red, swollen and when I touched it, even a little, it hurt like hell."
But he knew what it was: Gout.
Charles had heard about gout from other truck drivers and also recalled that his father suffered from it as well. So he popped some ibuprofens and the pain subsided in a few hours. Yet Charles didn't get any sleep and could only drive a few hours the next day.
Although there are no statistics of how many truckers suffer from gout, many are primed for this malady because of their lifestyle and eating habits. Sitting all day is not a cause, but eating a lot of purine-rich foods, such as meats, gravy, beer, are factors. So is being overweight, diabetic, being a male over 45, having high cholesterol, suffering from high blood pressure, taking certain medicines for high blood pressure and not drinking enough water.
Gout itself is a type of arthritis [for fast facts about gout from the National Institutes of Health, click here.] and “there's a familial connection, too," noted Dr. Marc Leavey, a primary care physician at Lutherville Personal Physicians, a part of Mercy Medical Center in the Baltimore area. "If your father had gout, you may have it," he explained.
Gout is triggered by high uric acid levels in the bloodstream and the “crystals” that form from uric acid can lodge in the joints, causing excruciating pain.
"The other thing with an excess of uric acid, is that it causes kidney stones,” added Leavey. “That is something that you don’t want to get, because it hurts worse than having a baby.”
The most important issue with gout is prevention, he noted: Keeping away from proscribed foods and staying hydrated are vital. "I can imagine that if you're driving a truck, you don't want to drink a lot of water because you don't want to stop and pee," Leavey said.
Also, you should check your high blood pressure medications as some can actually increase uric acid levels, making you more prone to getting a gout attack or a kidney stone.
“In that case, you may want to talk to your doctor about using a different medication so that you don’t have that problem,” Leavey noted.
What can you do if you suffer an attack while on the road?
"There are medicines that we use to treat gout ranging from an anti-inflammatory like ibuprofen and Naproxen,” he pointed out.
“You may have those with your already, and they work very well. We also use steroids occasionally, Cortisone or drugs like that to help to ease the acute inflammation,” Leavey said. “An older drug, which is called Colchicine, is used, too, although it has to be prescribed judicially because it can cause very bad GI (gastrointestinal) side effects. Keeping the joint supported, not walking on the toe, and putting an ice pack on it can also help as well. Those are the initial things to stop an attack."
For the long term, Leavey said a truck driver afflicted with gout needs to develop a working relationship with his doctor to say, “Look, if I call you and I’m on the road and I’m in Butte, Montana, and I got an attack, can you tell me what to do?”
Leavey added that if a driver is getting more than one or two attacks in a year, they ought to consider using medication.
As a side note, why the big toe is a common target for gout attacks is not fully understood. "It's a big joint. It is susceptible to stress because we walk on it every day and it gets a lot of movement,” Leavey noted. “Gout just has a predilection for that joint. I don't know if anybody’s ever answered that question, though I've seen gout in wrists, knees and other joints.”
Many truck drivers swear by cherry juice as a cure for flare-ups of gout, but Leavey is skeptical.
"Cherry juice is one of those things that have been around for years,” he said. “I don't know of any controlled studies that say it works. Because gout can be self-limiting, it’s possible that it just got better on its own. There’s no harm to using cherry juice; that’s certainly fine, but an over-the counter, anti-inflammatory is the quickest way to handle an attack."
Leavey added that certain footwear may help, too. "Footwear that relieves pressure and gives the joint support certainly may help to prevent an attack, because it is oftentimes the repeated trauma that seemingly brings on an attack," he noted.
As for Charles, he's on medication for his gout. "I never want to have that pain again,” he said.