Personal experiences and conversations with others help fuel my discussion on situations that caregivers face. Let us start by declaring that pain is not normal. When someone complains or describes feelings of discomfort and pain, it needs addressing, especially in our elders. We know the causes could stem from an array of conditions. The condition we will discuss is gout. It is a disorder that affects weight-bearing joints. The big toe is the most common site of complaint and pain, but it can affect ankles, heels, knees, and fingers. It is not to be confused with arthritis, which can also be debilitating. Not all individuals with arthritis will have gout, but the pain is the classic reality of them both.
Gout is a metabolic disorder. It is associated with elevated urate levels in the body. It is sometimes known as an inflammatory form of arthritis. An acute flair is painful and hindering, because urate crystals can form in joints. You may also hear the term gouty arthritis. The development of gout can stem from hereditary or high-risk behaviors like alcohol consumption, drug use, or eating foods high in purines (purines are molecules made up of carbon and nitrogen atoms found in our cells). There are two types of purines. They are endogenous and exogenous.
The ones most concerning are exogenous purines, meaning foods that may be eaten and the body cannot get rid of the by-products. Uric acid (hyperuricemia) is the by-product, and in high amounts, it can settle in joints causing pain, sometimes very severe. Joints can swell, limiting mobility. There is a lab test that can show high uric acid levels in the blood (acute gout flair). Once determined, care must center on pain relief, comfort measures, and foods that are not high in purines.
Moderation and Action Items
Gout is a treatable condition and caregivers can help manage this condition by controlling the foods prepared and if on medication, ensuring it is given as prescribed. As a caregiver, a huge part of your role is education, to decrease the burden of harm. For care recipients with a history of gout, certain precautions must be taken.
Avoiding organ meats, excessive alcohol use, and some seafood, (anchovies, cod, herring, haddock, mackerel, and sardines) will help. Shellfish (mussels, scallops, clams, squid, and shrimp) must be provided with caution. Ensure daily hydration is adequate.
As Your Proactive Caregiver Advocate, it is always prudent to consult your healthcare practitioner for questions, concerns, and treatment options for a loved one with gout. Seeking nutritional support can also be valuable to help with dietary changes. Be safe! Be well!
Dr. Cynthia J. Hickman is a retired registered nurse and case manager; CEO of Your Proactive Caregiver Advocate and author of From the Lens of Daughter, Nurse, and Caregiver: A Journey of Duty and Honor, and The Black Book of Important Information for Caregivers. Website: www.cynthiajhickman.com.