The joint at the base of the big toe on my right foot has become increasingly painful, red and inflamed over the last 4 days. I contacted the acute oncology service yesterday, but they weren’t particularly interested as I have a review with my consultant tomorrow. After an increasingly painful night, I rang them again this morning. The nurse on the triage line today remembered me from last September. She had been the person who dealt with me when I was sent up to the assessment unit after my night in A&E. She had also been on duty on a couple of the days when I went in as a day patient for IV steroids. Perhaps knowing my history made her a bit more inclined to investigate, or perhaps I was more insistent.
Step 1 was to send in photos of my foot. At this point I was grateful of the choice of anatomy, I have definitely read reports of people having their email accounts suspended after sending photos of more sensitive body parts to their doctor. I don’t think my feet would be of interest even to a foot fetishist. The photos clearly revealed that one foot was redder and more swollen than the other. I soon got a call back, inviting me to vascular scanning (to rule out blood clots) followed by a visit to the assessment unit. It’s amazing how quickly oncology can get scans scheduled when they want.
Vascular scanning is a new department to add to my hospital department bingo game. I attended with my husband, as I can’t drive with a foot that won’t flex. We were soon joined in the department by an old work colleague and his wife, there to check out whether he had a DVT. So that made the time pass easily as we had lots to catch up on. Vascular scanning is an ultrasound process. Lots of cool gel and a probe. The operator was a bit surprised I had been sent there for a problem in my foot, as they can only scan the leg. The scanning process starts at the groin and works down to the ankle. Unsurprisingly, no blood clots were found.
Up on the assessment unit, bloods were taken to check for infection and also uric acid levels. The doctor’s first question was had I ever suffered from gout? The answer is no, but the penny dropped that this is a more than possible consequence of the kidney damage I sustained in September’s immune checkpoint inhibitor induced nephritis. It also backed up my theory that being co-incident to a reduction in steroids indicated the higher level of steroids had been masking this issue.
Dr Google tells me acute flare ups of gout are usually of only a few days duration. They seem to be caused by the uric acid forming needle like crystals which then escape the cartilage and irritate the bones. I have been given ibuprofen gel to help reduce inflammation and pain (I am still not allowed oral NSAIDS because of the kidney damage). Tomorrow, I get to review with my consultant what to do next on the steroid front. I think the answer has to be stay put until the acute phase has passed. Most of the things they could give me to reduce uric acid levels seem to be off limits because of my kidneys, so I don’t know whether any further treatment will be offered. I will be recalled for an x-ray to check there hasn’t already been bone damage.
Family and friends think this is really funny. I am getting lots of jokes about cheese and port (yes I like both, although port isn’t a regular part of my diet). Lifestyle advice has not been given, but I am conscious I have gained weight during my 7 months on steroids, and could helpfully do something about that. I am also not as active as I was or I would like, thanks to the impact of all these little things upon me. One thing I do know is that I won’t be giving up cheese anytime soon!
