You’re more likely to develop gout if you have high levels of uric acid in your body.

Factors that increase the uric acid level in your body include:

• Medical conditions. Certain diseases and conditions make it more likely that you’ll develop gout. These include untreated high blood pressure and chronic conditions such as diabetes, metabolic syndrome, and heart and kidney diseases.
• Family history of gout. If other members of your family have had gout, you’re more likely to develop the disease.
• Age and sex. Gout occurs more often in men, primarily because women tend to have lower uric acid levels. After menopause, however, women’s uric acid levels approach those of men. Men also are more likely to develop gout earlier — usually between the ages of 30 and 50 — whereas women generally develop signs and symptoms after menopause.

People with gout can develop more-severe conditions, such as:

• Recurrent gout.

  Some people may never experience gout signs and symptoms again. But others may experience gout several times each year. Medications may help prevent gout attacks in people with recurrent gout. If left untreated, gout can cause erosion and destruction of a joint.

• Advanced gout.

  Untreated gout may cause deposits of urate crystals to form under the skin in nodules called tophi (TOE-fie). Tophi can develop in several areas such as your fingers, hands, feet, elbows or Achilles tendons along the backs of your ankles. Tophi usually aren’t painful, but they can become swollen and tender during gout attacks.

• Kidney stones.

  Urate crystals may collect in the urinary tract of people with gout, causing kidney stones. Medications can help reduce the risk of kidney stones.

“”Gout is a common type of inflammatory arthritis. It causes pain, swelling, and redness in one or more joints. It usually happens as a flare, which can last for a week or two and then gets better. The flares often begin in your big toe or a lower limbGout happens when too much uric acid (urate) builds up in your body over a long time. Uric acid is a waste product your body makes when it breaks down purines. Purines are substances that are in your body’s tissues and in many foods.

When your body breaks down old cells or digests foods that contain purine, most of the uric acid that’s made dissolves in your blood. Your kidneys filter the uric acid out of your blood, and it leaves your body in your urine.

However, sometimes your body can make too much uric acid or does not remove enough of it. Then the uric acid levels build up in your body, including in your blood. Having too much uric acid in the blood is called hyperuricemia where the uric acid has to placed elsewhere in the body (joints, toe, etc…) This is what causes the pain in those areas.”.

MedlineLine (https://medlineplus.gov/gout.html)

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)

Complications:

Alcohol depresses your central nervous system. In some people, the initial reaction may be stimulation. But as you continue to drink, you become sedated.

Too much alcohol affects your speech, muscle coordination and vital centers of your brain. A heavy drinking binge may even cause a life-threatening coma or death. This is of particular concern when you’re taking certain medications that also depress the brain’s function

Impacts on your safety:

Excessive drinking can reduce your judgment skills and lower inhibitions, leading to poor choices and dangerous situations or behaviors, including:

• Motor vehicle accidents and other types of accidental injury, such as drowning
• Relationship problems
• Poor performance at work or school
• Increased likelihood of committing violent crimes or being the victim of a crime
• Legal problems or problems with employment or finances
• Problems with other substance use
• Engaging in risky, unprotected sex, or becoming the victim of sexual abuse or date rape
• Increased risk of attempted or completed suicide

Drinking too much alcohol on a single occasion or over time impacts health problems:

• Liver disease. Heavy drinking can cause increased fat in the liver (hepatic steatosis), inflammation of the liver (alcoholic hepatitis), and over time, irreversible destruction and scarring of liver tissue (cirrhosis).
• Digestive problems. Heavy drinking can result in inflammation of the stomach lining (gastritis), as well as stomach and esophageal ulcers. It also can interfere with absorption of B vitamins and other nutrients. Heavy drinking can damage your pancreas or lead to inflammation of the pancreas (pancreatitis).
• Heart problems. Excessive drinking can lead to high blood pressure and increases your risk of an enlarged heart, heart failure or stroke. Even a single binge can cause a serious heart arrhythmia called atrial fibrillation.
• Diabetes complications. Alcohol interferes with the release of glucose from your liver and can increase the risk of low blood sugar (hypoglycemia). This is dangerous if you have diabetes and are already taking insulin to lower your blood sugar level.
• Sexual function and menstruation issues. Excessive drinking can cause erectile dysfunction in men. In women, it can interrupt menstruation.
• Eye problems. Over time, heavy drinking can cause involuntary rapid eye movement (nystagmus) as well as weakness and paralysis of your eye muscles due to a deficiency of vitamin B-1 (thiamine). A thiamine deficiency also can be associated with other brain changes, such as irreversible dementia, if not promptly treated.
• Birth defects. Alcohol use during pregnancy may cause miscarriage. It also may cause fetal alcohol syndrome, resulting in giving birth to a child who has physical and developmental problems that last a lifetime.
• Bone damage. Alcohol may interfere with the production of new bone. This bone loss can lead to thinning bones (osteoporosis) and an increased risk of fractures. Alcohol can also damage bone marrow, which makes blood cells. This can cause a low platelet count, which may result in bruising and bleeding.
• Neurological complications. Excessive drinking can affect your nervous system, causing numbness and pain in your hands and feet, disordered thinking, dementia, and short-term memory loss.
• Weakened immune system. Excessive alcohol use can make it harder for your body to resist disease, increasing your risk of various illnesses, especially pneumonia.
• Increased risk of cancer. Long-term excessive alcohol use has been linked to a higher risk of many cancers, including mouth, throat, liver, colon and breast cancer. Even moderate drinking can increase the risk of breast cancer.
• Medication and alcohol interactions. Some medications interact with alcohol, increasing its toxic effects. Drinking while taking these medications can either increase or decrease their effectiveness, or make them dangerous.What to expect to report to your doctor.Before your appointment, make a list of: Consider your drinking habits, taking an honest look at how often and how much you drink. Be prepared to discuss any problems that alcohol may be causing. You may want to take a family member or friend along, if possible. If you want to stop drinking, there is help. Start by talking to your health care provider. Treatment may include medicines, counseling, and support groups.

Alcohol can damages our cells and this can stop cells repairing damage.  Alcohol effects chemical signals which can make cells more likely to divide this in turn increases the chance of cancer to develop.  Alcohol makes it easier for cell in our mouth and throat to absorb cancer causing chemicals.

There are many ways that alcohol can cause cancer. Some of the main ways are:

• Damage to cells. When we drink alcohol, our bodies turn it into a chemical, called acetaldehyde. Acetaldehyde can damage our cells and can also stop cells from repairing this damage.
• Changes to hormones. Alcohol can increase the levels of some hormones in our bodies such as oestrogen and insulin. Hormones are chemical messengers, and higher levels of oestrogen and insulin can make cells divide more often. This increases the chance that cancer will develop.
• Changes to cells in the mouth and throat. Alcohol can make it easier for cells in the mouth and throat to absorb harmful chemicals that cause damage.

Remember, it’s the alcohol itself that damages your body, even small amounts. It doesn’t matter whether you drink beer, wine or spirits. All types of alcohol can cause cancer.

There’s plenty of tricks that people claim ‘cure’ hangovers. But even if they work for your hangover, they don’t reverse the damage caused from drinking alcohol.

What types of cancer does alcohol cause?

Drinking alcohol causes 7 different types of cancer. This includes:

• Breast cancer and bowel cancer (two of the most common types)
• Mouth cancer
• Some types of throat cancer: oesophagus (food pipe), larynx (voice box) and pharynx (upper throat)
• Liver cancer
• Colon and Rectum

Treatments for alcoholism disorder may include:

• First know treatment for alcohol use disorder can vary, depending on your needs. Treatment may involve a brief intervention, individual or group counseling, an outpatient program, or a residential inpatient stay. Working to stop the use of alcohol to improve quality of life is the main treatment goal.Detox and withdrawal. Treatment may begin with a program of detoxification or detox — withdrawal that’s medically managed — which generally takes two to seven days. You may need to take sedating medications to prevent withdrawal symptoms. Detox is usually done at an inpatient treatment center or a hospital.  Learning skills and establishing a treatment plan. This usually involves alcohol treatment specialists. It may include goal setting, behavior change techniques, use of self-help manuals, counseling and follow-up care at a treatment center.
• Psychological counseling. Counseling and therapy for groups and individuals help you better understand your problem with alcohol and support recovery from the psychological aspects of alcohol use. You may benefit from couples or family therapy — family support can be an important part of the recovery process.
• Oral medications. A drug called disulfiram (Antabuse) may help to prevent you from drinking, although it won’t cure alcohol use disorder or remove the compulsion to drink. If you drink alcohol, the drug produces a physical reaction that may include flushing, nausea, vomiting and headaches. Naltrexone (Revia), a drug that blocks the good feelings alcohol causes, may prevent heavy drinking and reduce the urge to drink. Acamprosate (Campral) may help you combat alcohol cravings once you stop drinking. Unlike disulfiram, naltrexone and acamprosate don’t make you feel sick after taking a drink.
• Injected medication. Vivitrol, a version of the drug naltrexone, is injected once a month by a health care professional. Although similar medication can be taken in pill form, the injectable version of the drug may be easier for people recovering from alcohol use disorder to use consistently.
• Continuing support. Aftercare programs and support groups help people recovering from alcohol use disorder to stop drinking, manage relapses and cope with necessary lifestyle changes. This may include medical or psychological care or attending a support group.
• Treatment for psychological problems. Alcohol use disorder commonly occurs along with other mental health disorders. If you have depression, anxiety or another mental health condition, you may need talk therapy (psychotherapy), medications or other treatment.
• Medical treatment for health conditions. Many alcohol-related health problems improve significantly once you stop drinking. But some health conditions may warrant continued treatment and follow-up.
• Spiritual practice. People who are involved with some type of regular spiritual practice may find it easier to maintain recovery from alcohol use disorder or other addictions. For many people, gaining greater insight into their spiritual side is a key element in recovery.
• Things you would let your doctor know in your original visit would include:   Any symptoms you’ve had, including any that may seem unrelated to your drinking.  Key personal information, including any major stresses or recent life changes.  All medications you might be taking, vitamins or other supplements that you’re taking, and their dose.

Article revised on April 1, 2024 Elizabeth Lynch RN