GOT GOUT?

FHM (Philippines) - - Contents - JUJU BALUYOT

It's not just an old man's sick­ness any­more

Ervin Cari­aso, 35, an ar­chi­tec­tural con­sul­tant, de­scribes what it’s like to have an at­tack of gout. “It was just last May. As in ma­jor at­tack to and I had to take a two-day rest. Hindi [ako] makalakad, eh. This was right af­ter our com­pany’s din­ner and dance where I was part of the mu­si­cal pre­sen­ta­tion. Imag­ine kung umatake yun dur­ing the night of the event, di ba?

“Nag­sisim­u­lang ma­mula yung paa, usu­ally malapit ta­laga sa toe. Masakit, parang umi­init. Af­ter sig­uro mga five hours, ma­pa­pansin mo parang may bu­mubukol na. Ayun, ang sakit na nun. Ga­nun na siya for two to three days usu­ally. Masakit ta­laga kung sa masakit,” Cari­aso adds.

An­other gout suf­ferer, Juan Car­los De Leon, 29, an ad­min­is­tra­tive per­son­nel for a real es­tate com­pany, says you can’t com­pare it to any other type of pain. “I cry. I shout—a lot. As in ev­ery move I make, sasakit siya nang so­brang sakit. Tapos even the pulse beats cause too much pain es­pe­cially dur­ing the first two days.

Gout is an episodic painful form of in­flam­ma­tory arthri­tis due to in­creased uric acid. Decades ago you would have only heard about gout from your ag­ing par­ents, but th­ese days the dis­ease ap­pears to be the ul­ti­mate party pooper to your en­joy­ment of food and drink and, in­creas­ingly, your youth.

“There is an ob­ser­va­tion that there seems to be younger pa­tients who get af­flicted [with gout],” says Philip­pine Rheuma­tol­ogy As­so­ci­a­tion Pres­i­dent Heizel Reyes. “Those with fam­ily his­tory are also at an in­creased risk. Pa­tients with co­mor­bid dis­eases such as kid­ney im­pair­ment, blood dis­or­ders, or heart dis­ease are also at higher risks by virtue of the dis­ease it­self or the med­i­ca­tions used for th­ese.”

Data from a 2015 PRA study show that there are 1.6 mil­lion Filipinos suf­fer­ing from gout. THEN-PRA pres­i­dent Eric Amante said that they even ex­pected the num­ber to con­tinue to in­crease be­cause of peo­ple’s un­healthy life­styles.

“It’s 1.6 mil­lion. But if you look at the preva­lence in the Philip­pines, it’s in­creas­ing in the past two decades. We have a lot of bread­win­ners who have gout and I think it’s very im­por­tant to re­mem­ber that this is a chronic ill­ness,” Amante said. “Chronic” means it stays with you— for a long time.

THE SIGNS OF GOUT

If there is one thing that Cari­aso has learned from his gout, it is to be a more think­ing ne­ti­zen in the age of so­cial me­dia. “This is how I got my gout: Nagka­roon ng trend noon, yung pag-inom ng soya milk. As in ev­ery morn­ing bago ako puma­sok sa of­fice, umi­inom ako nun. Ang alam ko na­man kasi is healthy na­man ang soya milk.”’

That’s what he thought—un­til he started feel­ing its ef­fects. “Af­ter a year of drink­ing soya milk, bigla na lang sumakit yung paa ko. Doon sa may joint ng big toe. At first I thought na-sprain o napi­layan lang ako. Kaso ev­ery day, la­long sumasakit siya at mas nag­ing swollen ta­laga yung paa ko,” Cari­aso says.

“The only way to con­firm ta­laga is to take a blood test. So right af­ter of­fice, I went to the doc­tor then yun na nga. Con­firmed that it’s gout. Mataas yung level ng uric acid ko... Sabi niya most likely ay ta­la­gang sa soya milk yun kasi aside from that, ac­tu­ally ay puro healthy na­man ang ki­nakain ko kasi me­dyo con­scious na­man ako with the food I eat. Yung sa soya milk lang ta­laga,”cari­aso adds.

Too much of some­thing was also the case of De Leon. He’s been suf­fer­ing from gout for a decade now—mean­ing he got it when he was only 19. “Liver was my ul­ti­mate [fa­vorite food] then, and huge serv­ings of monggo. Yun, pa­borito ko ta­laga. Tapos I also oc­ca­sion­ally drink, eh beer trig­gers gout. My doc­tor said high uric acid is caused by eat­ing too much food that are rich in purine like beans, meat, deep-sea fishes, in­nards, and in­ter­nal or­gans like liver. Eh di ba nga, pa­borito ko ta­laga nun ang liver tapos monggo pa.”

“When it first hits you, you wouldn’t know im­me­di­ately that you have gout,” says rheuma­tol­o­gist Dr. Isagani Gabonada. “You’ll most prob­a­bly think that it’s just nor­mal body pain caused by ex­haus­tion from your ac­tiv­i­ties. Yung sa kaso nila (De Leon and Cari­aso), kung sinasabi nila at am­i­nado sila mahilig sila noon sa soya milk at la­man-loob there could re­ally be high chances na they got it from those food. You get gout from purine-rich food, no. 1 na nga diyan yung mga la­man-loob.”

Cari­aso con­sid­ers him­self still

“Parang tin­u­tu­sok ng pako nang paulit-ulit, pero ang pinagkaiba lang ay hindi nag­dudugo. Mabi­gat ta­laga, parang pin­up­w­ersa sa’yo yung sakit. There are times na mag­dadasal ka na lang na ma­putol yung paa mo para wala ng pain.”

lucky that his gout at­tacks don’t hap­pen of­ten. There are times when symp­toms get worse, known as “flares,” and there are times when there are no symp­toms at all, known as “re­mis­sion.” You can never know when flares will at­tack. As scary as it may sound, it will hap­pen when it hap­pens.

“Min­san hindi mo ta­laga mararam­daman na may gout ka eh. Bi­hira lang ako atak­i­hin, twice a year lang. Pero ka­pag inatake na­man ako, one month ‘yun be­fore to­tally mawala ang sakit,” Cari­aso says.

THE CAUSES AND EF­FECTS

Gout is caused by hy­pe­r­uricemia, when there is too much uric acid in the body. Ac­cord­ing to the Cen­ters for Dis­ease Con­trol & Preven­tion, the body makes uric acid when it breaks down purines, which are found in the body and the food that you eat. When you have too much uric acid, monosodium urate can build up in joints, flu­ids, and tis­sues within the body. Th­ese urate “crys­tals” cause the pain, which some de­scribe as like walk­ing on bro­ken glass.

Gout has of­ten been ref­er­enced as a “rich man’s dis­ease” be­cause you get a lot of uric acid when you eat hearty, of­ten meat-based dishes, that the com­mon folk usu­ally don’t get to dig into. But mod­ern so­ci­ety has changed all that. In the age of fast­food and food pro­cess­ing, we are all sus­cep­ti­ble to the dis­ease.

Dr. Gabonada sees the threat ev­ery­where. “[For ex­am­ple, in food parks], I see my daugh­ters’ so­cial me­dia feeds and lagi silang nasa food parks, kain sila nang kain kasama ang mga kaibi­gan nila. Tapos ayun, French fries na punong­puno ng cheese. Mga shake na may mga naka­p­a­tong na na­pakaram­ing cook­ies. Kung anu-anong street food na pina­sosyal pero ba­si­cally ay street

food pa rin. So­brang daming ar­ti­fi­cial fla­vor­ings at kung anu-anong chem­i­cal. Kum­baga ay pro­cessed food. Ang gout, nakukuha ta­laga yan with too much in­take of un­healthy food and yung mga alak at sigar­i­lyo, lalo na yung alak. Ano ba na­man ang ma­g­a­gawa ko at ng iba pang med­i­cal pro­fes­sion­als para mapig­i­lan ang trend na ganyan? Kaya ngayon, ayan ang nagig­ing re­sulta.”

PRA Pres­i­dent Reyes con­curs with Dr. Gabonada. “One factor [of hav­ing gout] may be diet and life­style. There is more pro­cessed food and su­gared bev­er­age that is avail­able [in the mar­ket] and, hence, con­sumed.”

To say that gout af­fects the qual­ity of life of those af­flicted with it would be a gross un­der­state­ment. If not treated or given at­ten­tion, chronic gout could po­ten­tially lead to kid­ney stones, joint ero­sion and de­for­mi­ties, and even kid­ney fail­ure.

While gout is not con­sid­ered a fa­tal ail­ment, its ef­fects are painful, hence it could af­fect a per­son’s per­for­mance in school or work. It could even po­ten­tially lead to anger, de­pres­sion, and over­all, poor qual­ity of life.

“Sana mas nag­ing aware ako noon sa mga food na ki­nakain ko. Too much some­thing is bad. Too much su­gar can lead to di­a­betes. Too much salt can dam­age your kid­neys. Too

much uric acid can cause gout. Sabi nga nila, nasa huli ang pag­si­sisi. To­too ta­laga yun,” Cari­aso says.

WHAT TO DO

If you do not have gout yet but fear that you might be on your way to it, maybe it’s time to visit a doc­tor. “Gout, if caught early, is very amenable to treat­ment. Med­i­ca­tions are read­ily avail­able and are af­ford­able, [al­though] treat­ment du­ra­tion de­pends on the stage of gout,” Reyes says.

Mean­while, those who are al­ready af­flicted with gout have to make some sac­ri­fices, or risk the dis­ease get­ting worse. In the case of De Leon, he had to give up his love for monggo and liver. Cari­aso, mean­while, no longer drinks soya milk any­more.

“Foods to avoid are those with high uric acid con­tent [such as] mga la­man-loob, sar­dines, red meat, pro­cessed food [and] sweet­ened bev­er­ages,” Reyes says. “Take a lot of wa­ter so uric acid can be flushed out of the sys­tem. There [are] also some stud­ies that say con­trolled in­take of dairy prod­ucts is also ben­e­fi­cial.”

It is also im­por­tant to get phys­i­cally ac­tive as it helps ex­crete the ex­cess uric acid from your body. Gabonada sug­gests that adults be ac­tive for 150 min­utes ev­ery week. Some of the ac­tiv­i­ties that he sug­gests in­clude walk­ing, swim­ming, or bik­ing 30 min­utes a day for five days a week. “Malak­ing bagay ang pagig­ing phys­i­cally ac­tive kasi pwede ta­la­gang mabawasan yung risks na may ma-de­velop pa na ibang chronic dis­eases aside sa gout, gaya ng heart dis­eases and di­a­betes.”

De Leon has an ad­vice to those who love food-bing­ing with­out tak­ing a close look at their nu­tri­ent con­tent. “Don’t wait un­til it hap­pens to you. I tell you, this [gout] is the mother of all KJS (killjoys).”

‘Ang gout, nakukuha ta­laga yan with too much in­take of un­healthy food and yung mga alak at sigar­i­lyo, lalo na yung alak. Ano ba na­man ang ma­g­a­gawa ko at ng iba pang med­i­cal pro­fes­sion­als para mapig­i­lan ang trend na ganyan? Kaya ngayon, ayan ang nagig­ing re­sulta.” — Dr. Isagani Gabonada, rheuma­tol­o­gist

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