Gout. Ever since I arrived in Samoa, more so in Savaii, it has amazed me
how little people understand about GOUT and its management. It doesn't surprise
me that from their own childhood education they may have never heard of it (ie
health education in schools is minimal..down to the basics only ie. the birds
and the bees and stds and thats it) But the fact that they GOT an attack, got
seen by a doctor and got started on painkillers - kinda blows me that at no
point did someone NOT tell them about uric acid, and Allopuriol.
For those of you who have not heard of or know anyone with- gout is a
type of arthritis caused by a build up of an acid called URIC ACID.Many meats
and foods are high in this acid so heavy consumption of certain foods brings on
an attack. These attacks can be severe and debilitating. It may not look so bad
(ie a red joint of big toe) but don't be fooled, this baby will make grown men
cry...What baffles me is the number of people on rescue remedy only. Wait for
gout attack (which may be as often as every week- ie imagine 2 or 3 days of
every week being incapacitated by a sore foot which can not even touch the
floor for fear of excruciating mind blowing pain resulting in 2 or 3 days of
absolute dysfunction (ie in bed all day) ) and then Voltaren Voltaren Voltaren.
To make matters worse, along the way someone may have slipped them some
"Superman" pill..also known as steroids ...also known as
Dexamethesone resulting in a quick but FAKE improvement of pain due to
its powerful anti inflammatory effect. Anyways, my point is these remedies
treat the PAIN only. And not the culprit- uric acid. Which means that these
individuals just run these vicous circles of not treating the cause but
treating the symptom of pain only, at the same time abusing Voltaren and Dexa...which
later results in CUSHINGS SYNDROME (another illness) Hypertension , Ulcer (from
Voltaren abuse) and kidneys that are SHOT.
What I am battling now- is explaining this to patients who have
done 10 yrs of this. And now look at me funny like Im lying to them-
Allopurinol?? (the treatment remedy which over time can rid excess uric acid
from the body and thus improve and hold off gout attacks forever if you are
compliant ) what is that?? Are you sure? no ones ever mentioned that
to me before?Oh wait a minute, thats that tablet you take once a day?yea it
doesnt work I took it for 2 days and it did nothing to the pain (Where I then explain it does not treat pain and still get
funny looks) Why do you want to stop my Voltaren addiction?? and worse yet- WHY are you not
giving me DEXA??arrhhhh....
where I worked overseas..we were forbidden to prescribe dexamethasone..this was
reserved for specialist consultant only in clinic or for admitted patients in
hospital. IF you were bad enough you'd get Prednisone (hospitalised
patients get- Pred is a weaker Steroid) but never Dexa. In Samoa , there
is a dexa craze. Every time I see someone on it, they almost always have the
Cushings Side effect , and when you decline giving it to them again, they
mutate into these angry stubborn begging beings- ie. "Please please please
give me dexa, I can not live a normal life without it!", I
promise I wont take it until absolutely necessary (which when out of my site is
like, everyday according to the patient) bla bla bla. Sometimes, the
husbands send the wives in to get it...and they do the exact same thing, whine,
complain, beg, lie....from - but this is my husbands standing order, and who
and who said he needed to take it everyday, to please my husband will beat me
if I dont come back with it...and then I find out, that he initially got it
from a friend of a friend who shared some of his- ….OMG , but that is a
norm in Samoa.
Honestly, the sweet little old lady in a muumuu suddenly gets all huff
and puffy and angry when I don't prescribe these things, and the men just go
bezerk...they pull out every excuse in the book like its a life and death
matter and then give me the "I'm a Matai" look and just do as I say line..sorry bro..not gonna work- my policy is FIRST DO NO HARM....it is most certainly not a life and death matter...you walked in here without as much as a
hobble...you don't need Dexa!!
Seriously, getting people off these terrible rescue remedies that lead
to a continued vicious circle of attacks (and not to mention terrible side
effects) and onto the needed Allopurinol is just a mission. You'd think I
was dealing with a drug addict trying to come off morphine or something.
Thats not to say there aren't people who Allopurinol does not work for-
like any drug, there are some who it doesn't work for, for whatever reason, as
well as those who get bad side effects. But for a lot of people, this drug
would really do them so much good if they only gave it a good go.
I've made a pamphlet now, that explains it all. Prevention, treatment,
etc....seems like when you give someone a piece of paper it seems a little more
truthful then when it comes out of my mouth. I tell myself not to take it
personally as I think many people think I am younger then I actually am (thanks
for being vertically challenged! ) and so I guess are a little less
trusting of a young doctor maybe?? Anyways...I've also had patients come in
Absolutely gobsmacked at the improvement since starting Allopurinol. Like
seriously these people did not think they could ever live normal lives again,
and now can...so that is pretty satisfying. I just hope that more and more people
learn about this and realise there is actually a treatment for this
debilitating illness:) Thats all for now have a great week everyone!!
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