Hi. My name is Jason, and I have gout.

If you don’t have any first-hand knowledge of the so-called “disease of kings,” consider yourself extremely lucky. I wouldn’t wish this shit on anyone, not even Dick Cheney, and my Loyal Readers all know how I feel about that guy. I can honestly say without exaggeration or hyperbole that I cannot imagine any pain worse than what I experience at the peak of a full-on outbreak of gout, except maybe a burn. A napalm burn, to be exact.

But Bennion, you’re asking, what exactly is this horrible affliction, and how can it be so horrible without having its own telethon?

Well, gout is essentially a form of arthritis caused by an excess of uric acid in the blood. The body generates uric acid as it metabolizes a type of protein called purines, and in the vast majority of people, it’s not a problem. Your kidneys scrub out the substance and it’s eliminated from the body the next time you go to the bathroom. But for some reason, it is a problem for me. There are two possible things going on in my body: I might be a uric acid-producing machine that simply pumps out way too much of the stuff, or I might be producing a normal amount of it but my kidneys are slackers that aren’t up to dealing with it. Genetics are probably involved, and diet (i.e., eating too many foods rich in purines) can be a contributing factor as well (although my understanding is that diet isn’t as big a factor as people generally believe). Also, a whole raft of medical conditions can exacerbate the problem, including obesity, high blood pressure, and diabetes.

In any event, the extra uric acid that I’m not managing to pee away has to go somewhere, so it turns into tiny needle-shaped crystals, which then accumulate in my joints. Gravity tends to draw them down into the extremities; like most gout victims, my symptoms present in my feet. The crystals themselves don’t cause the painful outbreaks, though. Rather, your body’s own immune system will suddenly take notice of those foreign interlopers hiding between the bones and send the troops to try and roust them out, and that in turn inflames all the surrounding tissues. And that’s when the fun begins.

Imagine waking in the middle of the night with your big toe swollen to nearly twice its normal size, the skin stretched taut and shiny red, and hot to the touch as if you have a fever. The joints are stiffened so you can’t bend the toe normally, and the affected area is shockingly tender to the touch. You realize you can’t find any comfortable angle, no way to position your foot so it doesn’t hurt. Even the weight of a thin cotton sheet across the toe is impossible to bear — again, I am not exaggerating or making this up! You swear you can feel gravity itself pressing down around the sore digit like a lead sock. And placing your full body weight on the toe is a 180-proof shot of pure agony. The first time I had an attack, before I was diagnosed, when I had no idea what was happening, I thought I’d somehow broken the damn thing. (I spent a couple of days wracking my brains trying to figure out what kind of damn-fool thing I’d done to accomplish that; learning I had a chronic disease usually associated with much older, much fatter men somehow failed to soothe my wounded pride.)

Fortunately for me, my outbreaks are intermittent and usually pretty short. The peak discomfort levels typically last only two or three days, followed by a week or so of slow, incremental improvement, during which the hissing-inhalation-through-the-teeth kind of pain fades, but the whole damn foot still aches and throbs like a cavity-riddled tooth. Normal walking becomes a sort of dream, something you remember doing in a previous life that now seems impossibly remote. You can’t wait to be able to put on a shoe without feeling like Kevin Costner struggling with his boot in the opening moments of Dances with Wolves. (I can hardly stand to watch that scene, I relate so fully with it!)

And then one morning you wake up, and the gout is just… gone. Like a summer thunderstorm that blows away as abruptly as it boiled up out of the desert. The relief I feel taking my first step on a pain-free and fully functional foot is nearly impossible to describe without sounding more melodramatic than I already have. Let’s just say it’s a wonderful feeling indeed.

As you might have guessed by now, I’m currently in the midst of a gout attack. It’s relatively minor compared to some I’ve had, but it’s the first in quite a while — over a year, as best I can recall — and it’s really gotten to me this time. I’ve been feeling downright despondent, to be honest, and I’m not entirely sure why. Maybe because it has been so long since the last one, I allowed myself to start thinking it wouldn’t ever come back. I don’t know…

Exhaustion probably has something to do with it. As I said, it’s hard to get the inflamed foot into a comfortable position, and very hard to sleep with a constant, pulsing pain clamoring for your attention. Not to mention the quietly nagging thought that if you twist the wrong way, put too much pressure on the foot, get it tangled in the covers, any one of a hundred innocent mistakes that you wouldn’t even notice during a normal week, the pain you’re managing to tolerate right now will rocket up the scale and knock the needle right off the gauge. I think I’ve only managed three or four hours a night for about a week now.

Sleep deprivation aside, this condition is mentally taxing in other ways, as well. You become extremely conscious of your feet when you have gout: their size, where they are in relation to everything else, and especially what possible dangers might be around. The ordinary bumps and stumbles that everyone inflicts on themselves everyday must now be avoided at all costs, because a stubbed toe will seem like the end of the world, believe me. Pets and small children tromping carelessly into your personal space are cause for alarm, and finding yourself in a milling crowd can lead to an outright panic attack. Riding the train to work probably elevates my blood pressure ten points; I can’t tuck the foot too far back under the seat, because bending it hurts, so I just have to glare at the the oblivious college students and middle-aged commuters, and hope nobody stumbles over me when the train lurches into motion.

You also become hyper-aware of what’s going on during the mere act of walking, how many bones have to flex just so, and in what directions they’re bending and deforming, how much pressure is placed on various parts of the foot at any given point during the step. And you learn how everything connects to everything else, and how much posture and gait affect the rest of the body. After a week of limping around and favoring my left side, I feel about 157 years old; my back hurts, my hips and knees ache, and a whole assortment of muscles keep threatening to charley-horse on me.

As I sit here thinking about it, I realize that the worst part really isn’t the pain, after all, it’s the exhaustion… the complete mental and physical fatigue generated by being in pain and on your guard every minute for days on end.

There’s emotional fatigue as well. Me being me — prone to over-analyzing everything, making mountains out of molehills, and generally taking the weight of the world onto myself — I feel guilty for not managing to be more stoic about this. As I said, I’m having a minor outbreak. It’s not even in my toe this time, it’s in the ankle and the bones across the top of my foot, the ones that bark at you if you lace your shoes too tightly; this is pretty uncomfortable, but it’s not nearly as crippling as when the toe flares up. At least I can get my shoe on without biting on a stick. By contrast, one of my coworkers who suffers from gout was recently out of the office for over a week because he couldn’t walk — the shit had attacked both his knees — and I know another guy who has such constant, unrelenting pain from his gout that he’s had a morphine pump implanted. A fracking morphine pump. Like they give cancer patients.

And then there’s my friend Diane, who does not have gout but instead had her first hip replacement at the age of eight and has endured three since, who walks with a cane and prays that today isn’t the day when the current hip finally breaks and who hurts every damn day of her life. What right do I have to feel any self-pity at all when I see what she goes through just to go walk from our cubicle-island to the break room for a cup of tea?

But it’s hard to keep others in mind when you’re hurting yourself, and obsessing over the perfectly ordinary things you can’t do today because your damn foot won’t support your weight. That plays hob with your self-image and your self-esteem. I was never much of an athlete, but when I look at old photos and remember how effortless and un-self-conscious I used to be about moving, about simply walking, the way I took it for granted that everything would just work… when I think about how much walking I did in England and Germany and New York and all the cool places I’ve been and still want to go, and about the horrific possibility of having a gout attack while traveling… well, it’s just one more damn reason to feel like I’m getting old. Like my prime years are behind me. I know other people are worse off than me. And I feel for them, I really, truly do. But that doesn’t mean I’m not feeling what I feel.

Dejected? Hell, yes, I’m dejected.

And now that I’ve got all that off my chest, I’m going to the kitchen for another fistful of ibuprofen and an icepack…