What is Gout?

It is characterized by sudden, severe attacks of pain, redness and tenderness in joints, often the joint at the base of the big toe.

Gout — a complex form of arthritis — can affect anyone. Men are more likely to get gout, but women become increasingly susceptible to gout after menopause.

Fortunately, gout is treatable, and there are ways to reduce the risk that gout will recur.

The signs and symptoms of gout almost always occur suddenly — often at night — and without warning.

They include:

• Intense joint pain. Gout usually affects the large joint of your big toe, but it can occur in your feet, ankles, knees, hands and wrists. The pain is likely to be most severe within the first four to 12 hours after it begins.
• Lingering discomfort. After the most severe pain subsides, some joint discomfort may last from a few days to a few weeks. Later attacks are likely to last longer and affect more joints.
• Inflammation and redness. The affected joint or joints become swollen, tender, warm and red.
• Limited range of motion. Decreased joint mobility may occur as gout progresses.

What actually causes gout?

Gout occurs when urate crystals accumulate in your joint, causing the inflammation and intense pain of a gout attack. Urate crystals can form when you have high levels of uric acid in your blood.

Your body produces uric acid when it breaks down purines — substances that are found naturally in your body, as well as in certain foods, such as steak, organ meats and seafood. Other foods also promote higher levels of uric acid, such as alcoholic beverages, especially beer, and drinks sweetened with fruit sugar (fructose).

“Ordinarily, this very painful stage of bursitis begins to recede in four or five days, although it may take longer. When the pain is no longer acute, therapy must be radically changed. At this point, it becomes essential to return full, normal movement to the joint. Naturally, this should be done slowly and cautiously.”

NATURAL PEDIA Nature of the world.  Naturally. (naturalpedia.com)

How a MD diagnoses Bursitis:

1 – Doctors can often diagnose bursitis based on a medical history and physical exam but if further testing needed the M.D. will do the following:

2 – Imaging tests. X-ray images can’t positively establish the diagnosis of bursitis, but they can help to exclude other causes of your discomfort. Ultrasound or MRI may be used if your bursitis can’t easily be diagnosed by a physical exam alone.

3 – Lab tests. Your doctor may perform blood tests or an analysis of fluid from the inflamed bursa to pinpoint the cause of your joint inflammation and pain.

Treatment for Bursitis:

Bursitis treatment usually involves conservative measures, such as rest, ice and taking a pain reliever. If conservative measures don’t work, treatment may include:

• Medication. If the inflammation in your bursa is caused by an infection, your doctor might prescribe an antibiotic.
• Therapy. Your doctor may recommend physical therapy or exercises to strengthen the muscles in the affected area to ease pain and prevent recurrence.  When cleared by PT or OT it is up to you to continue those exercises the rest of your life unless your MD tells you otherwise.
• Injections. Your doctor may inject a corticosteroid drug into the bursa to relieve inflammation in your shoulder or hip. This treatment generally brings rapid pain relief and, in many cases, one injection is all you need.  It cause anti inflammatory effects to the area.
• Assistive device. Temporary use of a walking cane or other device will help relieve pressure on the affected area.
• Surgery. Sometimes an inflamed bursa must be surgically drained, but only rarely is surgical removal of the affected bursa ever needed and if told necessary by the MD a second opinion never hurts even though it is time consuming and that is up to you.

Measures you can take to alleviate the pain of bursitis:

• Rest and immobilize the affected area
• Apply ice to reduce swelling
• Take an over-the-counter medication, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others), to relieve pain and reduce inflammation
• Cushion your knees if you sleep on your side by placing a small pillow between your legs
• Avoid elbow pressure by not leaning or placing your weight on your elbows to rise from a lying position or if taking long drives and leaning on the Right elbow or Left elbow on the door or console.

Measures you can do to prevent Bursitis:

While not all types of bursitis can be prevented, you can reduce your risk and the severity of flare-ups by changing cushioning your areas of where bursitis can take place:

• Using kneeling pads. Use some type of padding to reduce the pressure on your knees if your job or hobby requires a lot of kneeling.
• Lifting properly. Bend your knees when you lift. Failing to do so puts extra stress on the bursae in your hips.
• Wheeling heavy loads. Carrying heavy loads puts stress on the bursae in your shoulders. Use a dolly or a wheeled cart instead.
• Taking frequent breaks. Alternate repetitive tasks with rest or other activities.
• Walking around. Try not to sit in one position too long, especially on hard surfaces, because that puts pressure on the bursae in your hips and buttocks.
• Maintaining a healthy weight. Being overweight places more stress on your joints.
• Exercising. Strengthening your muscles can help protect your affected joint.
• Warming up and stretching before strenuous activities to protect your joints from injury.

Revised 4/02/24 by Elizabeth Lynch RN BSN

“Bursitis is inflammation or irritation of a bursa sac. You have these sacs all over your body. They’re filled with fluid that helps ease rubbing and friction between tissues like bone, muscle, tendons, and skin. Bursitis is common around major joints like your shoulder, elbow, hip, or knee.”

WebMD

Common areas you experience the diagnosis:

Shoulder bursae

Elbow bursae

Hip  & Back bursae

Knee Bursae

What bursitis is?

Bursitis (bur-SY-tis) is a painful condition that affects the small, fluid-filled sacs — called bursae (bur-SEE) — that cushion the bones, tendons and muscles near your joints. Bursitis occurs when bursae become inflamed.

The most common locations for bursitis:

1 – The shoulder 2 – The elbow  and 3 – The hip.

4 – But know you can also have bursitis by your knee, heel and the base of your big toe. Bursitis often occurs near joints that perform frequent repetitive motion.

The signs and symptoms of bursitis:

1 – Feel achy or stiff

2 – Hurt more when you move it or press on it

3 – The site affected looks swollen and red

When to see a Doctor:

Consult your doctor if you have:

• Disabling joint pain
• Pain for more than one to two weeks
• Excessive swelling, redness, bruising or a rash in the affected area
• Sharp or shooting pain, especially when you exercise or exert yourself
• A fever going to a systemic infection from localized where the bursitis is probably.

The most common causes of bursitis:

1 – The causes are repetitive motions or positions that irritate the bursae around a joint.

Examples include:

• Throwing a baseball or lifting something over your head repeatedly
• Leaning on your elbows for long periods
• Extensive kneeling for tasks such as laying carpet or scrubbing floors
• Prolonged sitting, particularly on hard surfaces

2 – Injury or trauma to the affected area

3 – Inflammatory arthritis such as rheumatoid arthritis or gout, and even infection.

Anyone can develop bursitis, but certain factors may increase your risk.

Risk Factors for bursitis:

1 – Age. The occurrence of bursitis becomes more common with aging.  Why the more wear and tear to the area and repetitively injuring or trauma or inflammation for what ever reason to the site.  Just like a car more the more wear and tear to the car the more work needs to be done to it.

2 – Occupations or hobbies.  

If your work or hobby requires repetitive motion or pressures on particular bursae, your risk of developing burisitis increases (take baseball especially a pitcher for 10 plus years playing as opposed to one year playing again there is more wear and tear to the older pitcher so higher potential for the older pitcher to get bursitis but not in all cases.  Today for some pitchers they throw 100 mph or more which you see at times the young one injured before as opposed to the older one throwing only at 80 mph or less more often depending on the player.  Look how many times in a year a pitcher is thrown out for the season due to an injury to the arm or shoulder for that reason.

Examples in your job could also include carpet laying, tile setting, gardening, painting and even playing a certain instrument for types of bands or orchestras.

Examples of hobbies that could cause bursitis is sports like baseball and certain instruments already mentioned especially for how many times you play it a year and how repetitive in how much time a session or game.  Other hobbies could computer playing doing long time sitting to the hip or typing with the elbows leaning, etc…

So be more mindful of repetitive motions you may do at work or out of work.

3 – Other medical conditions.  Certain systemic diseases and conditions — such as rheumatoid arthritis, gout and diabetes — increase your risk of developing bursitis.

Revised 4/02/24 by Elizabeth Lynch RN BSN

“The less alcohol you drink, the lower your risk for cancer. Some studies show that drinking three or more alcoholic drinks per day increases the risk of stomach and pancreatic cancers. There is also evidence that drinking alcohol increases the risk for prostate cancer. All alcoholic drinks, including red and white wine, beer, and liquor, are linked with cancer. The more you drink, the higher your cancer risk.  In 2020 to 2025 The Dietary Guidelines for Americans recommends that adults of legal drinking age to choose not to drink or drink in moderation = 2 drinks or less a day for men and a drink or less in women a day.  If you don’t drink than don’t start drinking.  Don’t drink if you are under 21, pregnant, with a medical condition or health problem that could worsen from drinking, driving, on medications without checking with your MD, and a recovering alcoholic.”

Centers for Disease Control and Prevention – CDC (https://www.cdc.gov/cancer/alcohol/index.htm)

“According to the ARDI application, during 2020–2021, excessive alcohol use was responsible for about 178,000 deaths and 4 million years of potential life lost each year, on average. More than one third of these deaths and nearly half of the years of potential life lost were due to binge drinking.  Keeping in mind alcoholism effects our health over long time heavy drinking one aspect alone the B/P.  Drinking a lot of alcohol can affect the muscles in your blood vessels. This can cause them to become narrower. The more alcohol you drink, the higher the risk of developing hypertension. If you drink regularly you are at risk, especially if you’re over the age of 35.  High Blood Pressure can cause deaths or long term health problems.”

ARDI/CDC – Centers for Disease Control and Prevention

“Specifically, Neuroticism has been recognized as the strongest predictor among other personality traits that discriminate between non-drinkers, drinkers, and moderate drinkers in women (Lac & Donaldson, 2016), with lower scores in binge drinkers (Adan et al., 2017).  Neuroticism is defined as a tendency toward anxiety, depression, sensivity, self-doubt, sensitive, and other negative feelings. A chronic disease in which a person craves drinks that contain alcohol and is unable to control his or her drinking. A person with this disease also needs to drink greater amounts to get the same effect and has withdrawal symptoms after stopping alcohol use.  You don’t have to have these symptoms to be an alcoholic or drinking too much.  Heavy Drinking is considered:

• NIAAA defines heavy drinking as follows:
  • For men, consuming five or more drinks on any day or 15 or more per week
  • For women, consuming four or more on any day or 8 or more drinks per week
• SAMHSA defines heavy alcohol use as binge drinking on 5 or more days in the past month
• Less you drink the better for your mind and body health.”

National Institute on Alcohol Abuse and Alcoholism

(https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking)

Alcoholism, or alcohol dependence, is a disease that causes

• Craving – a strong need to drink
• Loss of control – not being able to stop drinking once you’ve started
• Physical dependence – withdrawal symptoms
• Tolerance – the need to drink more alcohol to feel the same effect

With alcohol abuse, you are not physically dependent, but you still have a serious problem. The drinking may cause problems at home, work, or school. It may cause you to put yourself in dangerous situations, or lead to legal or social problems.

Alcohol use disorder (which includes a level that’s sometimes called alcoholism) is a pattern of alcohol use that involves problems controlling your drinking, being preoccupied with alcohol, continuing to use alcohol even when it causes problems, having to drink more to get the same effect, or having withdrawal symptoms when you rapidly decrease or stop drinking.Unhealthy alcohol use includes any alcohol use that puts your health or safety at risk or causes other alcohol-related problems. It also includes binge drinking — a pattern of drinking where a male consumes five or more drinks within two hours or a female downs at least four drinks within two hours. Binge drinking causes significant health and safety risks.  If your pattern of drinking results in repeated significant distress and problems functioning in your daily life, you likely have alcohol use disorder. It can range from mild to severe. However, even a mild disorder can escalate and lead to serious problems, so early treatment is important.

Another common problem is binge drinking. It is drinking about five or more drinks in two hours for men. For women, it is about four or more drinks in two hours.

Too much alcohol is dangerous. Heavy drinking can increase the risk of certain cancers. It can cause damage to the liver, brain, and other organs. Drinking during pregnancy can harm your baby. Alcohol also increases the risk of death from car crashes, injuries, homicide, and suicide.

Genetic, psychological, social and environmental factors can impact how drinking alcohol affects your body and behavior. Theories suggest that for certain people drinking has a different and stronger impact that can lead to alcohol use disorder.

Over time, drinking too much alcohol may change the normal function of the areas of your brain associated with the experience of pleasure, judgment and the ability to exercise control over your behavior. This may result in craving alcohol to try to restore good feelings or reduce negative ones.**

Alcohol use disorder can include periods of alcohol intoxication and symptoms of withdrawal.

Alcohol use disorder can be mild, moderate or severe, based on the number of symptoms you experience. Signs and symptoms may include:

• Being unable to limit the amount of alcohol you drink
• Wanting to cut down on how much you drink or making unsuccessful attempts to do so
• Spending a lot of time drinking, getting alcohol or recovering from alcohol use
• Feeling a strong craving or urge to drink alcohol
• Failing to fulfill major obligations at work, school or home due to repeated alcohol use
• Continuing to drink alcohol even though you know it’s causing physical, social or interpersonal problems
• Giving up or reducing social and work activities and hobbies
• Using alcohol in situations where it’s not safe, such as when driving or swimming
• Developing a tolerance to alcohol so you need more to feel its effect or you have a reduced effect from the same amount
• Experiencing withdrawal symptoms — such as nausea, sweating and shaking — when you don’t drink, or drinking to avoid these symptoms
• Risk factors for alcohol use disorder include:
• Steady drinking over time. Drinking too much on a regular basis for an extended period or binge drinking on a regular basis can lead to alcohol-related problems or alcohol use disorder.
• Age. People who begin drinking at an early age, and especially in a binge fashion, are at a higher risk of alcohol use disorder. Alcohol use may begin in the teens, but alcohol use disorder occurs more frequently in the 20s and 30s. However, it can begin at any age.
• Family history. The risk of alcohol use disorder is higher for people who have a parent or other close relative who has problems with alcohol. This may be influenced by genetic factors.
• Depression and other mental health problems. It’s common for people with a mental health disorder such as anxiety, depression, schizophrenia or bipolar disorder to have problems with alcohol or other substances.
• Social and cultural factors. Having friends or a close partner who drinks regularly could increase your risk of alcohol use disorder. The glamorous way that drinking is sometimes portrayed in the media also may send the message that it’s OK to drink too much. For young people, the influence of parents, peers and other role models can impact risk.
• Alcohol withdrawal can occur when alcohol use has been heavy and prolonged and is then stopped or greatly reduced. It can occur within several hours to four or five days later. Symptoms include sweating, rapid heartbeat, hand tremors, problems sleeping, nausea and vomiting, hallucinations, restlessness and agitation, anxiety, and occasionally seizures. Symptoms can be severe enough to impair your ability to function at work or in social situations.

To all have a Happy Easter and safe one!