Best Foot Forward

Kidney failure will shock you into taking good care of yourself. Still, the pain from attendant gout is excruciating, making walking a chore. But a dose of humor — and a very restricted diet — are steps toward progress

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Photograph by Joe Vaughn

Jim McFarlin, Freelance Writer
Stage IV Kidney Failure

Feets, you have failed me now.

Evidence suggests you initiated your betrayal the night of April 17, 2009, when I decided to surprise Karen (my wife) with a romantic night on the town, beginning with a Tony Bennett concert at Sound Board in MotorCity Casino. Afterward, we elected to stay in the casino for dinner, and I feasted on one of the most succulent charbroiled sirloins you can imagine, with all the trimmings — béarnaise sauce for the meat, hollandaise for the asparagus, a little extra sauce on the side for good measure.

I can still taste that meal in my mind today. Which is a good thing, since it was likely the last such spread I will ever enjoy.

The next night, the mere touch of the sheet against my left foot caused me to awaken and bolt upright in bed in excruciating pain. The richness of that post-Tony dinner had triggered a severe case of gout in both feet. And please save the jokes about it being a wealthy man’s condition or the comparisons to Henry VIII; when your feet have swollen to half beyond their normal size, nothing really seems all that amusing. Now, I have fairly massive puppies to begin with — 15 DD — but seeing them bloated to elephantine proportions was a horror right out of Ripley’s Believe It or Not.

My family physician, a caring and wonderful man named Geoffrey Trivax, said there were several medications he normally might recommend to treat the disorder — something called allopurinol among them. However, he was reluctant to prescribe anything for my gout because of the root cause behind the affliction: Earlier, I had been diagnosed with Stage IV kidney failure.

At Stage V, I’ve been told, one should begin gathering the family and making arrangements, so, all things considered, Stage IV isn’t the end of the world. But my kidneys have become more precious and delicate than the Iranian Crown Jewels, and Trivax was loath to propose any treatment that might cause them further damage. Allopurinol potentially was such a drug.

Because my kidneys are losing the ability to filter my blood as they normally would, waste products like uric acid build up in my system instead of being discharged efficiently through the body. In my case, gout is the result. And if you’ve ever been stricken with it, you know this is true: If there’s somebody out there you absolutely can’t stand, don’t wish they were dead. That’s too quick, too final. Hope they develop a case of gout.

When you cannot walk without intense pain, your entire world changes. I quickly descended to using a cane, then a walker. At times, I chose to crawl to the bathroom or other places around my home because the thought of putting pressure on my feet was simply unimaginable. I talked myself out of going places I normally would visit without a second thought. For more than three months, with the aid of an incredibly supportive and attentive wife, I endured near-constant agony until I found another physician who said he was “not afraid” to prescribe allopurinol in combination with other drugs, in carefully monitored doses. (He’s not afraid? I thought. He’s not taking the pills! What about me?)

While the gout now appears to be under control, damage has been done. My stride, once quick and light, seems plodding and unsteady. Most of my shoes no longer fit. Stairs are a challenge. Even stepping off the curb has become an adventure. Still, I’m thankful for my present state, because I know the situation could be far worse. Gout is merely the most obvious — and painful — manifestation so far of a dangerous, potentially life-threatening disease. As my kidney specialist, or nephrologist, the gentle and intense Dr. Fawaz Al-Ejel, once told me, “Your kidneys will never hurt. Pain won’t indicate the severity of your condition.”

What happened to them? Trivax suggests the problem began to surface as far back as June 2001, when routine tests revealed unusually high amounts of protein in my urine. Hey, that’s a good thing, right? I reasoned. We all need protein, and I’ve got so much, I’m pissing it away! Such naiveté could explain why I’m not a doctor. The protein, coupled with a mild elevation of my creatinine (cree-AT-in-een) levels, was enough to raise concern. (Creatinine, a chemical waste molecule generated from muscle metabolism and an indicator of renal function, may be the most important word in the kidney patient’s vocabulary. Those afflicted compare and share their numbers like golfers discussing their low scores.)

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