Acute gouty arthritis (Gout) and Kidney cancer surgery complications

Gout afflicts men more often than women four to one, and twice as many black men get gout as white men. Men usually have their first occurrence around forty years of age. Women have their first occurrence after menopause.

During a gout attack the gout can move from one joint to another, and settle in more than one joint. Whether the gout settles in the foot, elbow, wrist,knee or ankle the pain is excruciating and the sufferer cannot bare to be touched much less use the affected joint. The uric acid crystals are sharp and cause inflammation and swelling. The swollen joint becomes hot and red and puts even more pressure on the nerves.

Even with medication gout can become chronic. With more than two gout attacks in one year you are considered to be to be at risk for joint damage. The uric acid can build up in the kidneys causing kidney stones or even kidney failure.

Kidney cancer is not common but again it is more common in men. It occurs around the age of sixty-four and it is most often found by accident when treating another problem. The patient I am writing about is sixty-three years old, a male and has had chronic gout for many years. His kidney cancer was discovered when he was being treated for kidney stones.

The Patient

After many tests the doctor concluded that the patient had a large tumor in his kidney and it was most likely cancerous. The good news was that it was contained within the kidney. The surgeon decided a simple nephrectomy (the removal of the kidney only) would be the most appropriate course of treatment.

Any one with chronic gout is at risk in any surgery for a gout attack to occur, but the removal of a kidney directly affects the uric acid levels and may cause a major gout attack for which a gout sufferer and his kidney surgeon should be prepared. If the gout is in the legs or feet the gout patient will not be able to get up and walk which is recommend after surgery.

Any change in the amount of uric acid in the body can trigger a gout attack. If you are about to have a kidney removed the chances of having a change in uric acid levels are 100%. You need to have a plan to deal with a major gout attack and how it would be handled. Hospitals are not accustomed to dealing with gout patients since they are rarely hospitalized for gout. Gout is usually not a death threatening condition. Doctors and nurses not accustomed to working with gout patients have no idea how painful and incapacitating gout can be.

Monday August 10th -- day of surgery.

The patient had the nephrectomey on Monday August 10th and the operation was a complete success. On day one and two the patient was up walking as much as was expected.

Wednesday August 13th -- major gout attack.

On day two the patient's kidney stopped producing urine and that night gout appeared in one leg. Next day it appeared in the other leg. Fortunately the kidney resumed its function. With gout now in knees, ankles and feet it was impossible to get up much less walk. Of course after a surgery such as this you are supposed to get up and walk to reduce the possibility of blood clots and pneumonia. The excruciating pain made it impossible to do so. The gout proceeded to settle in the wrist and elbows as well. At this time the patient could not use his arms and hands to pull himself up from the bed to even get in a position to walk. The piercing, excruciating pain was not understood by the nursing staff. They were very attentive and did their jobs well but they had never dealt with gout and the pain was underestimated. They thought he was just lazy and not wanting to suffer the pain of the opporation. That pain was nothing compared to gout in his ankles, knees, wrists and elbows.

Before the surgery the patient was taking Colchicine to control the gout, he intended to go to Allopurionol after seeing his Arthritis specialist. Allopurionol may not have prevented the attack after surgery because any change in uric acid can cause an attack and Allopurionol controls uric acid. Colchicine is not neutral to kidneys and cannot be taken if you have only one kidney. The patient was given prednisone to help alleviate the situation but it did little to help the patient’s condition.

Sunday August 16th -- release from hospital.

Sunday August 16 the patient was released from the hospital at 5:00p.m. It took twenty minutes to get from the wheel chair into the car. The main problem was the gout in his wrists, hands and elbow. Once home, it took two friends to get the patient into the house. It took him and his wife two hours to get him from the walker/wheel chair onto the couch. Patient could not put pressure on his arm and his wife could not lift him.

If the doctors treating the patient had had a true understanding of gout they would not have sent him home. The pain and inability to move was torture. The kidney surgeon told him he had to get up and walk around or he would get blood clots. The surgeon had no idea of the pain and the inability to walk. I state once more that he dismissed the patient not wanting to walk as laziness or not wanting to endure the pain of the operation -- the pain of the operation was nothing. The patient struggled to get up and walk but the pain was to excruciating. The gout was not taken seriously, they were treating it but without understanding the pain.

Make sure your doctor knows that if you are overcome with gout after your operation that you will not be able to walk -- explain the pain you may suffer. Do not let this happen to you.

Tuesday August 18th -- back to the hospital.

For two days the patient stayed on the couch unable to move, consumed with Gout. His legs were swollen three times their natural size. The skin was red and hot. Finally Tuesday August 18th the patient had to call 911 to get back to the hospital. The Paramedics were wonderful in their effort not to cause him pain but it could not be avoided. They had to roll him off the couchonto the strecher.

The hospital emergency room did a Myriad of tests because the edema was so bad. He was hospitalized again and this time put on bed rest. They discovered a small clot below the knee in one leg. This put even more limitations on what could be done for his edema.

August 21st -- released from hospital.

Friday August 21st he was again released from the hospital. He still needed help from his friend to get into the house but he was able to get from the walker/wheel chair onto the couch with the help of his wife.

Finally the Home Help nurse came and ordered a wheelchair and hospital bed. This made life a lot easier. Some days were better than others as the gout traveled through his body.

September 9th -- had to use hospital ambulance to visit nephrologist.

September 9 the patient went to see the Kidney Specialist (nephrologist). He now had gout in his entire body, even his neck and back. He was not as swollen but the gout had taken over completely. He even had uric acid crystals oozing from his finger. It looked like white toothpaste and dried hard as a rock. The white ooze is the uric acid that accumulates in the joints. The patient had to schedule a private ambulance In order to get to his appointment because he was in so much pain. It took two people to get him into the wheelchair and into the van, it would have been impossible to get him into a car.

The Kidney specialist (Nephrologists) put him on prednisone and indomethacin. The next day he saw immediate relief.

September 23rd -- patient finally able to move around on his own.

Today it is Wednesday September 23 and he is getting along much better. He is able to walk with crutches and get up the stairs and down the stairs with a lot of effort. The swelling is gone and the uric acid oozing from the finger is almost well.

Today he will begin allopurinol and it is hoped that his gout will be under control with this treatment since allopurinol is a drug that must be taken for the rest of your life he expects to be gout free.

October 10th -- patient is able to walk without crutches.

I have created this site in the hopes that no one else with gout will have to suffer what this patient suffered. The kidney removal for a gout sufferer is a very serious trigger, but any surgery can be a trigger along with stress. Have a plan, alert your doctors that you have gout, and protect yourself from this experience.

If you have questions about gout or kidney cancer check out these sites.

http://www.webmd.com/cancer/understanding-kidney-cancer?page=4

http://www.intelihealth.com/IH/ihtIH/WSIHW000/9339/9487.html

http://seer.cancer.gov/statfacts/html/kidrp.html