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This happened to me, too, but it was a boot for my lower leg/foot after breaking a toe. I wasn't aware it wasn't going to be covered by insurance so I accepted it from the orthopedist's office. They ended up charging me $275 (via insurance, which didn't cover it) for something I could have bought for <$50 myself.
People who are having frequent attacks need to be right on top of treating the pain and inflammation. Oftentimes you can reduce the severity of the attack some or a lot by being RIGHT on top of it.
Usually that means you need to have the necessary treatments on hand. By the time you've gotten and appointment with your doctor etc etc etc or even go to instacare of the ER, it's too late. You need to start treating the INSTANT you feel that slightest twinge.
Sometimes this is enough to head off an attack altogether.
Also many doctors put patients who are starting in an allopurinol, or increasing the dosage, on a low-ish daily dosage of colchicine as a preventative measure. I would definitely be talking to his doctor about that idea.
As far as treating an attack that is just starting (ideal situation) or is underway, you have basically three options. All of them need to be started AS SOON AS POSSIBLE:
- A course of steroids (something like prednisone). This can work wonders. If he could start this even tomorrow he would probably be feeling a lot better within a day or two. A doctor can prescribe this.
- Colchicine. This works very well for many people. It avoids the problems with too-often repeated rounds of steroids and NSAIDs, so is very good from that perspective. If you're in the U.S. unfortunately the cost is very, very high right now. But if you have good insurance it is still pretty reasonable and if you don't you can order from, say, a Canadian pharmacy with a U.S. doctor's prescription and the cost is not that high.
- NSAIDs. Ibuprofen, meloxicam, naproxen, etc etc etc. (medical overview here). The trick is, to knock back a gout attack you need to take enough of the NSAID to reach it's anti-inflammatory effect. So that means taking them at or pretty close to their highest recommended dose for something like 2-4 days. If you just take one every now & then when you feel like it or whatever you'll be getting the pain relieving effect of the NSAID but not the anti-inflammatory effect. Which is what you need to knock down a gout attack.
So with NSAIDs it is more like a high dose for a short time (a few days) just when you need it. And start it--at the high dose--at the very first sign of an attack. If you do that, you can often nip an attack in the bud.
Then get off it, as soon as the attack subsides. If you've been aggressive in treating the attack with enough of the NSAID to be effective, you might need to take it for just a day or two.
(The alternative to this approach--high dosage but short time frame, then off it altogether--is taking a little bit here & there when you feel like you need it. Unfortunately that approach brings all the disadvantages of NSAID use without ever reaching their main advantage.)
The problem with NSAIDs is they are a very bad idea for people with kidney disease or injury, and that includes a lot of people with gout. It might apply to your dad depending on where he stands with his diabetes situation. This is the sort of thing it's worthwhile to discuss with his doctor.
One advantage of NSAIDS is, if he can take them, you can start this at home using over the counter products--ibuprofen, alleve, etc. You don't need a doctor's prescription.
- Other pain relief options.
* Tylenol/acetaminophen can help with pain. If in extreme amounts of pain many people will alternate taking acetaminophen with an NSAID, as they complement each other in the pain relief department and you can generally take both of them simultaneously at their highest recommended dose (but obviously check with your doctor about this idea). Also, it's available OTC, meaning you could start this right away.
However, keep in mind that the tylenol won't do anything at all to address the underlying cause of the gout attack. So, probably not the best as the first line of attack. But don't underestimate the benefits of reducing/eliminating pain. It's more important than most people give credit.
* Any other type of pain reliever (hydrocodone, Tylenol 3, etc etc) is well worth asking for, even if just for a few days at the peak of an attack, if you're already doing everything else you can. Gout can be excruciatingly painful and there is literally no reason to suffer.
Other random bits of advice:
- Stay well hydrated at all times.
- As others mentioned, sometimes you can identify specific food triggers. But this is generally nibbling around the edges of the problem at best. Effective treatment is the allopurinol to reduce blood uric acid levels over time and the gout attack treatments mentioned above.
- For walking about when the flare is bad (when he needs to reach the bathroom etc) I highly recommend an ortho boot. It is SO much better than walking on the side of your foot and all those other tricks people try. You can put padding under various parts of the foot to take the pressure off the most sensitive parts. But the boot immobilizes the foot and, particularly, the toe so that they are not bending all the time.
FWIW these are two cam walker boots I've ordered from Amazon, a short one and a long one:
This isn't an extra-super recommendation for either Amazon or either of those boots, but I have ordered and used both of those particular models and they are OK. Any one you can get your hands on is probably OK. For more severe attack I would be thinking of the longer one, if possible, just because it immobilizes things better.
By the way, completely immobilizing the leg as though you had a broken ankle or something is probably not a good idea at all. But putting it on the hobble down to the bathroom or around the house a bit is probably a lot better than just walking on the side of your foot as many of us do.
Finally, the Arthritis Foundation page on treating gout attacks has a lot of good info: https://www.arthritis.org/diseases/gout
This isn't an extra-super recommendation for either Amazon or either of those boots, but I have ordered and used both of those particular models and they are OK. The tall one in particular I wore out the one my doctor gave me and the first one I ordered from Amazon, and now on my second one from Amazon. Luckily it hasn't been getting much use lately!