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my father is a 78 year old congestive heart patient, he is on diuretics 160mg everyday and has been suffering badly with gout. at the moment he appears to have an eruption on his big toe tha is badly infected. doctors gave him an iv of antibiotics today and two antibiotics to take for the next five days at home. will they have to operate on the toe when the infection has cleared as it appears to be tophi that he had before the eruption. please can you tell me what the next step is going to be so we can be prepared.
thank you
You really need to talk to your father's doctors about the future of his treatment.
The operation to remove tophi is simple from a surgical point of view, but surgery is never a welcome option for gout sufferers. Many patients report gout attacks following surgery, probably due to anaesthetics.
Tophi will grow again after removal, unless the cause is dealt with – high uric acid.
You should be discussing treatment options that lower uric acid below 5mg/dL. This will dissolve existing tophi, and prevent new ones forming.
Where gout is complicated with other diseases, as in your father's case, it is vital that cardiologists and rheumatologists work as a team to find compromises that give your father the best quality of life.
FORM,
The WORST thing for gout is the the use of diuretics…they retain copious amounts of uric acid while dumping excess sodium and fluid. It's a Hobson's choice though because diuretics are invaluable in the treatment of hypertension and heart failure. I am convinced my gout is CAUSED by diuretics (especially 15 years on thiazides for hypertension.)
These erupting tophi are the bodies only mechanism for removing large tophi. It is similar to way the body erupts a BOIL to remove poisons or the body performing surgery on itself. The exudations can be awful to look at but are really a healing process and they won't be a problem unless they become infected. The eruptions are common.
Probably an antibiotic ointment and regular cleaning/rinsing and sterile re-coverings are all good ideas. I had my thumb joint erupt this way and after years of living with the bump and its soreness, it went away as a result of the eruption, not even a scar.
Ask his cardiologist if the diuretics can be replaced with perhaps a calcium channel blocker or a beta-blocker. Trouble is that cardiologists have never heard of gout since med-school during the Renaissance and will pooh-pooh the idea becasue they view the entire world as on big heart. And, like I said, very few drugs can rival a diuretic (probably Lasix/furosemide?) for heart failure treatment.
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