Foot Care For You"Foot Surgery is a last resort, not first aid."- Dr. Burton Schuler
1976

Dr. Burton Schuler
Podiatrist - Foot Specialist - Foot Doctor
2401 W. 15th Street
Panama City, FL 32401

Hours: Mon-Thur 8:30 - 4 | Friday 8:30 - Noon
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"Common Foot Ailments"

Gout

Testimonials

REVIEWS OF DR. SCHULER

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Gout: Florida Podiatrist Presents Alternative Treatments

 

Dr. Burton S. Schuler a podiatrist, foot care specialist of  Panama City Fl,     has produced a series of five articles and a  video. about Gout that appears above  Gout is a painful arthritic condition caused by an excess of uric acid in the blood.  This final article of the series is about nutritional and natural treatment that the reader might want to consider when they are starting a treatment plan for gout.  Dr. Schuler is not advocating the use of any of the below but is presenting them to complement his other articles and his video on gout. He is directing the readers to further investigate them and to consultation with their doctor to use them or not. Swelling of the feet is associated with a acute gouty attack

Nutrition:

Improved nutrition awareness is one basic way to prevent and treat gout.  This dictates that gout sufferers’ do not eat anything that will further increase uric acid in their system  The nutritional treatment of gout includes avoiding foods and beverages such as alcohol (especially beer), coffee, red meat, all organ meats, meat gravies and broths, sweetbreads, seafood (especially anchovies, mussels, herring, and sardines), spinach, asparagus, mushrooms, beans, lentils, and peas. 

On the other hand foods, such as unsweetened cherries, are good for treating gout: “The equivalent of 20 tart cherries inhibits enzymes called cyclooxygenase-1 and -2, which are the targets of anti-inflammatory drugs” In general cherries have also shown promise of being useful in decreasing joint pain in general. This is due to a compound known as anthocyanins that give tart cherries their color are likely responsible for their anti-inflammatory, pain-killing effect.

 Vitamins:

Certain vitamin supplements can also lead to high uric acid levels and then cause a gouty attack. These include excessive niacin (vitamin B3), Vitamin C, and salicylates (the active component of aspirin)   Two vitamin supplements acknowledged in the successful natural treatment for gout, and should ideally be taken together daily between meals are 

  1. 200-400 mg of Quercetin (which inhibits uric acid production) and 
  1. 200-400 mg of Bromelain that Bromelain contains proteolytic enzymes that help to break down proteins into smaller units. 

 Proteolytic enzymes work as anti-inflammatory agents in the body and are therefore beneficial for reducing the inflammation that is associated with gout. Bromelain may also increase blood flow to the inflamed area, and this can hasten and enhance healing during flare-ups Finally, Bromelain may block the production of kinins, which are substances that are thought to contribute to the swelling, inflammation and pain of gout.

 Good Food for Gout

What can you eat that is beneficial for treating gout?  Unsweetened cherries can be consumed whole or as a juice (see above). Also, milk, non-fermented milk products, cottage cheese, mozzarella, whey protein, egg whites, and pulp-free fruit juices are all very safe and do not exacerbate gout symptoms.  But perhaps one of the most important remedies for treating gout is also one of the most readily available: water.

 Water:

 The National Institute of Arthritis and Musculoskeletal and Skin Diseases  (a government agency)  suggest one of the easiest ways to treat a gout attack at home is by increasing your water intake. Many people drink coffee, soda, and energy drinks which do little to replenish kasino necessary bodily fluids, and they may, in fact, contribute to overall dehydration.  Drinking more non-caffeinated fluids, especially water, will increase your urine output.  Increased urine out can help flush excess uric acid out of the body, thus eliminating the essential factor that causes gout: excessive uric acid levels. At minimum, it is suggested to drink 64 ounces of water a day or more for general health, and especially if you suffer from any number of painful conditions, such as gout.

 Apple Cider:

In addition to increasing your water take, supplementing apple cider vinegar in your diet can also be a positive remedy for treating gout.  Apple cider vinegar is a known natural treatment for many conditions.  In Alkalize or Die, Theodore A. Baroody argues that apple cider vinegar can help shift the scale from a pH balance that”s acidic–causing gout–toward alkalinity.  “Baroody says drinking apple cider vinegar can break up uric acid crystals and prevent them from reforming in the joints. If you use apple cider vinegar to treat gout, you may notice an increase in symptoms, at least initially…this occurs because the uric acid causes some inflammation as the crystals dissolve, and these symptoms should subside within a few weeks (

 Finally, the benefits of epsom salt soaks can not be overlooked.   In a new 2012 article Epsom salts was presented as a possible treatment for gout. It is made from magnesium and sulfate, which are both very beneficial minerals used in natural Magnesium helps relieve muscle inflammation and pain: it also regulates electrolytes while improving nerve functioning.  Sulfates aid in the flushing of bodily toxins and help form joint proteins that ameliorate painful arthritic conditions such as gout.

 Whether you try one or all of these natural/ home remedies for treating gout, the above suggestions, in consultation with your physician, should get you started on your path to recovery. Of course do not over look all of the medications availably for gout, but again talk to your physician first. 

Dr. Burton S. Schuler is a foot doctor, foot specialist (Podiatrist), of Panama City, Fl and the director of the Ambulatory Foot Clinics Podiatric Pain Management Center. He is also the author of the new book Why You Really Hurt: It All Starts In The Foot 



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Foot Specialist explains more about new Gout medications

 

gout-podiatrist-dr-schuler-panama-city-fl

Painful inflamed big toe joint caused by Gout

In his previous You Tube Video and article about gout, Dr. Burton S. Schuler stated that gout is a form of painful arthritis caused by high uric acid levels in the blood, which affects joints, especially the big toe joint of the feet.  Schuler also says  that the pain in the joint occurs  when it becomes  inflamed with “gouty crystals”  that settle into  joint spaces. (See Merck Manual.) .  Since high uric acid levels cause this painful condition, the treatment goal is to block or lower uric acid levels through nutritional or medication.  The aim of this article is to discuss the types of medication used for treating gout.  Dr. Schuler’s next article will be about nutritional treatments for gout.

Colchicines has already been written about in a separate article by Dr Schuler.  So the other drugs for gout will be discussed here. 

 Allopurinol (Zyloprim): This drug is used millions of times aday  for the long term treatment of gout. According to the National Institute of Health, Allopurinol is in a class of medications called xanthine oxidase inhibitors, which help reduce the production of uric acid in the body It works by inhibiting the synthesis of uric acid and it is linked to vascular inflammation, and liver toxicity. These side effects require periodic liver enzyme and renal function tests and complete blood counts for patients on Allopurinol. . Allopurinol is also said to cause gastrointestinal intolerance, such as nausea and diarrhea, and rash develops in about 2% of its users.  Also, Allopurinol hypersensitivity syndrome which is a serve allergic reaction remains a major concern among physicians because it can be life threatening.  Allopurinol is also sometimes used to treat seizures, pain caused by pancreas disease, and certain infections. It is also sometimes used to improve survival after bypass surgery, to reduce ulcer relapses, and to prevent rejection of kidney transplants. Odd Facts: It can take many weeks/months before you feel better from taking this drug.  .  During that time your physician may start you on colchicine to prevent you from having a gouty attacks. 

Newer Drugs:

Uloric: According to the drug’s website, this relatively new and more effective drug is the first FDA approved for gout in forty years.  The drug’s goal is to stop the body’s transformation of purines into uric acid.  When compared with Allopurinol in clinical studies, patients taking 40mg of Uloric reached healthy uric acid levels as those on Allopurinol, and “Up to twice as many patients on Uloric 80 mg reached a healthy uric acid level as those on Allopurinol”   They also claim that when   again compared to Allopurinol, more patients’ with mild to moderate kidney problems reached healthier uric acid levels with Uloric. Also, Uloric can be said to be more convenient than Allopurinol since it is taken only once a day, almost anytime, while Allopurinol’s equivalent effective dosage requires taking a pill four times a day, with recommended dosages imbibed after meals for optimal effectiveness. 

 Lesinurad:   But for some gout sufferers, the side effects of both Allopurinol and Uloric are too severe for comfort.  In June, 2012, Andrea Biosciences, Inc. announced a preliminary study on a new drug, Lesinurad, intended for gout patients who exhibit intolerance to xanthine oxidase inhibitors like Allopurinol or Uloric According to the Lesinurad clinical trial announcement, 20% of patients report side effects with Allopurinol and 5% discontinue Allopurinol due to these side effects

Febuxostat: Is another new drug   in clinical trials that has shown a similar profile to Allopurinol. Liver function abnormalities, nausea, arthralgia and rash were the most commonly reported problems” (http://clinicaltrials.gov/ct2/show/NCT01508702).    

 Other Drugs: Research to develop medicines that treat gout symptoms is ongoing, and scientists are also studying which medicines most safely lower uric acid levels.  For example, a drug called Cozaar (Losartan) is used to treat high blood pressure, and it also lowers uric acid levels.  Fenofibrate is used to control certain fats in the blood, and it may increase the kidney’s ability to eliminate uric acid (http://www.medicinenet.com/fenofibrate-oral/article.htm).  A new medicine, a Urate oxidase; that  may change uric acid into an absorbable molecule is now under investigation  There is also  a new class of  drugs, called  Y-700 medicines  that decreases the amount of uric acid the body makes, that  are also being evaluated.

Dr. Burton S. Schuler is a foot doctor, foot care specialist (Podiatrist), of Panama City, Fl and the director of the Ambulatory Foot Clinics Podiatric Pain Management Center.He treats patients with gout on a regular basis.  He is also the author of the new book Why You Really Hurt: It All Starts In The Foot 

Dr. Schuler, explains Colchicine as treatment for Gout

 

colchicine chemical structure treatment for gout Dr. Burton S. Schuler Podiatrist Panama City, Fl

Chemical Structure of Colchicine

 This is the first in a series of articles   I will write about the drugs  for treating  gout.

Colichicine is the first drug used in the treatment of a acute gouty attack Gout is a metabolic condition caused by an elevation in uric acid in the bloodstream. This increase can lead to a abnormal deposit of painful  urate crystals in and around joints, and in  soft tissue  structures, Gout is the most common form of crystalline arthritis.

A gouty attack  is incredible painful.  It is not just painful but among the most painful conditions you can get. It occurs most commonly in the big toe joint with the foot becoming red hot and swollen, with limitation of motion.  The classic time for an attack of gout is early morning or late night. The underlying cause for this is due to reabsorption of excess joint fluid at night,  that results in the increase deposit of the very painful  uric acid crystals into the joint. You see if there is more fluid in the joint the urate crystal are in a liquid state and are less likely to  become painful because as a liquid they are floating around in the joint and not cutting into the joint  . Most patients are men  between the ages of 30-60, most commonly around 50.

History. Colchicine is from the plant Colchicum autumnale that is found in the Colchis area of Asia.  Colchicine was introduced for the therapy of acute gout by Anton von Storck in 1763,. Benjamin Franklin, had gout, and was  reputed to have introduced colchicine as a  therapy in the United States. Colchicine is a one of a kind anti-inflammatory drug, It’s single real use is for the treatment and prevention of gout and  gouty arthritis  Historically gout was divided into primary and secondary phases.. Colchicine is used in the first phase which is the acute, crushing pain when gout first hits.   It gives dramatic relief from this crushing pain  Four drugs of proven value are available and commonly used during the first phase, : col­chicine, phenylbutazone, indomethacin, and corticosteroids (or ACTH).  The second phase of the treatment of gout  is the long term management to prevent gouty attacks from coming  back which I will write about  in the future.

 The aim of Colchicine therapy is to reduce the severity of the gouty pain and quickly terminate the acute inflammatory process associated with it. The patient should also rest as much as possible during this attack and  immobilized and protected the effected area.  

Colchicine is also unique in that if the diagnosis is in doubt, a clear-cut response to colchicine is still widely used as confirmatory evidence of gout.

The response to this drug is often dra­matic. Joint pains and swelling begin to subside approximately twelve hours after the institution of therapy and in most instances pain is completely relieved in from one to two days. Over 95 per cent of acute attacks are materially benefited by a single course of colchicine. The response to colchicine is often disappoint­ing if the drug is started several days after the onset of acute symptoms; relief is usually prompt if therapy is begun at the very onset of the attack. Should no benefit occur, a second course can be given after an interval of three days; repetition sooner might precipitate marked gastrointestinal symptoms.

ACTION AND DOSE: . The patient should start taking the drug at the first appearance of symptoms of a gouty attack. Delay of a few hours in the treatment after the onset of acute gouty pains may increase the severity and pro­long the duration of the acute episode.The normal way you take Colchicine   for a acute gouty attack is  one or two .5 mg pill every 2 hours until pain decreases or until diarrhea, nausea or vomiting occurs. The average attack of gout requires approximately 10-12 tablets to suppress inflammation within  24 hours. 

SIDE EFFECTS: There are many side effects The most common side effects of colchicine are nausea, vomiting, abdominal pain,  diarrhea difficulty breathing; swelling of your face, lips, tongue, or throat.. Colchicine also may cause hair loss, weakness, and nerve irritation. All patients taking colchicine long-term require monitoring of their blood counts because it can cause  damage to their  bone marrow causing severe anemia, low white blood counts, and low platelets. Reduced white blood cell counts may increase the risk of infections. Colchicine also may cause muscle pain (myopathy) or severe muscle breakdown (rhabdomyolysis). Patients with renal or liver dysfunction or taking some other drugs (for example, simvastatin and other statins, gemfibrozil, fenofibrate), which also affect muscle tissue, are at a higher risk of developing rhabdomyolysis. 

Grapefruit and grapefruit juice may interact with colchicine and lead to potentially dangerous effects; be sure to ask your doctor about this. 

DRUG INTERACTION:  Colchicine can interact with many drugs. . Tell your doctor about all other medications you use, especially: cholesterol-lowering medicines such as atorvastatin (Lipitor), fenofibrate (Antara, Lipofen, TriCor), digoxin (Lanoxin, digitalis);gemfibrozil (Lopid), simvastatin (Zocor), lovastatin (Mevacor), pravastatin (Pravachol),  and antibotices such as erythromycin 

For more information about gout here is a video by Dr. Burton S. Schuler

 Dr. Burton S. Schuler is a foot doctor, foot specialist (Podiatrist), of Panama City, Fl and the director of the Ambulatory Foot Clinics Podiatric Pain Management Center. He is also the author of the new book Why You Really Hurt: It All Starts In The Foot 



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What Is Gout, and why is it misdiagnosed everyday by doctors.

Thousands of people are told every day that they have gout when they don’t.

What is Gout
Gout is a form of Arthritis, that is extremely painful and that can occur suddenly out of nowhere causing sore aching crushing feet, and  exquisite pain. It is caused by a build up of a chemical substance in our body called uric acid. It is these crystals of urate that causes the pain, mostly in the big toe joint in the foot and also the ankles. These crystals can also invade the tendons of the feet causing great pain in that area.
It is believed that gout is due to Inheritance, and affects men much more than women. It is also known that gout is diet driven. Certain foods such as shell fish, and red meats; among many others can trigger a gouty attack. We also know that other circumstance can bring on a gouty attack such as an infection, stress, accident, too much of the wrong food and/or drink, and surgery.
In the clinic any patient that I feel has gout, I advise him/her of one thing: “GOUT CAN KILL YOU” It must be treated by a medical specialist who knows what he or she is doing. You see the pain in your big toe is just the tip of the iceberg. Without you knowing it, gout is affecting your heart, lungs, and kidneys. The pain from the worst gout attack will go away on its own in 2 weeks. Once this happens you think you are are cured. You are not!! The abnormal level of uric acid is still in your blood doing damage to many organs in your body, even though you are not aware of it. My first choice to treat gout would be an internist. If this is totally not possible, contact your family doctor and see what he says.

Many physicians will tell their patients that they have gout just because their feet hurt alot. This is incorrect information. The doctor should take a blood test to make this important diagnosis. After 35 years I have found that the vast majority of patients who do have severe foot pains DO NOT have gout, but just a crummy pair of feet cause by their feet not working right, not by a chemical imbalance that is seen in gout.

About the Author: Dr. Burton S. Schuler foot doctor, foot specialist, podiatrist of Panama City, Fl and the director of the Ambulatory Foot Clinics Podiatric Pain Management Center and is a leading authority on the Morton’s Toe, Long Second Toe and it associated problems. He is the author of the newly published book about The Morton’s Toe, Why You Really Hurt: It All Starts In the Foot. The book is published by the La Luz Press, Inc and is disturbed national by the Cardinal Publishing Group. Why You Really Hurt: It All Starts In The Foot, is the story of how one bone in your foot could be the real reason for pains thru out your whole body. It is important because it offer the public new information about why millions of people suffer everyday with aches and pains, and offers new hope to get rid of problems they believed they would have to live with forever. It literally can be the “medical missing link”

Dr. Schuler, graduated from the N. Y. College of Podiatric Medicine in 1975 at the age of twenty-four, and has been in private practice ever since. In 1982, he published his first book, The Agony of De-Feet: A Podiatrist Guide to Foot Care. During his thirty-five year professional career, he has written for Collier’s Encyclopedia and various podiatric journals and publications. He has been interviewed by The New York Times, First in Women, and other publications. Dr. Schuler has appeared on hundreds of radio and television programs both here and aboard. He is a Diplomate of the American Academy of Pain Management, and the National Board of Podiatric Examiners. Dr. Schuler is certified as a wound specialist from the American Academy of Wound Management. His professional and civic accomplishments have earned his inclusion in the 1999-2002 Who’s Who in America (Marquis).