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I was recently in Manila to attend a family function. While there we had quite an interesting experience that began when my brother-in-law, a previously healthy 41-year-old white male of Croatian descent, came to breakfast one morning limping. As we sat in the hotel restaurant chatting over coffee and fresh mangoes, the rheumatologist in me could not resist asking to see his foot. He promptly complied, offering up his be-flip-flopped foot for me to examine.
As my sister put it, his foot looked exactly like all the pictures of gout one finds from doing a cursory Google search. I can only imagine she meant James Gillray’s 1799 caricature of podagra. Please permit me to indulge in an aside on the significance of the mythological reference: Podagra was the spawn of Bacchus’ seduction of Venus. Fittingly, in the 18th century gout was believed to be a consequence of too much alcohol and sex.
Being the responsible, newly minted rheumatologist that I am, I wanted to crystal-prove the diagnosis. Also, my brother-in-law still had a long vacation in front of him including another 8 days in Manila and 3 in Tokyo. We all wanted him to feel better so that he could enjoy his trip. But how to do so? More to the point, how to do so in Manila, where I am an ocean and a continent away from my office, my materials, and my microscope?
Supremely confident, I thought I would proceed anyway; tap the first metatarsophalangeal joint, maybe give him a steroid injection. I asked my sister to get materials: lidocaine, Kenalog, a few 3-cc syringes, a few 22- and 25-gauge needles, Betadine, sterile gloves, etc. I was prepared to give my old Philippine medical license number, but there was no need. Prescriptions are superfluous in my homeland. Interestingly, I found this to be true on a recent trip to Spain as well.
But my brother-in-law got in the way of my grand and grandiose plans. As he put it, there was no way he was going to let me MacGyver his toe. While I am no stranger to office and bedside procedures, this was completely unknown to him. There was no scenario in which he was going to let me near his inflamed and tender toe in the nonsterile environment of his hotel room!
In the end we settled on getting him some oral Prednisone, again, without need of a prescription. My initial dose of 40 mg have no effect, but when I put him on 80 mg, it worked like a charm. He was able to enjoy a few more beers, sweet succulent shellfish, and the splendor and strangeness of Tokyo.
I was recently in Manila to attend a family function. While there we had quite an interesting experience that began when my brother-in-law, a previously healthy 41-year-old white male of Croatian descent, came to breakfast one morning limping. As we sat in the hotel restaurant chatting over coffee and fresh mangoes, the rheumatologist in me could not resist asking to see his foot. He promptly complied, offering up his be-flip-flopped foot for me to examine.
As my sister put it, his foot looked exactly like all the pictures of gout one finds from doing a cursory Google search. I can only imagine she meant James Gillray’s 1799 caricature of podagra. Please permit me to indulge in an aside on the significance of the mythological reference: Podagra was the spawn of Bacchus’ seduction of Venus. Fittingly, in the 18th century gout was believed to be a consequence of too much alcohol and sex.
Being the responsible, newly minted rheumatologist that I am, I wanted to crystal-prove the diagnosis. Also, my brother-in-law still had a long vacation in front of him including another 8 days in Manila and 3 in Tokyo. We all wanted him to feel better so that he could enjoy his trip. But how to do so? More to the point, how to do so in Manila, where I am an ocean and a continent away from my office, my materials, and my microscope?
Supremely confident, I thought I would proceed anyway; tap the first metatarsophalangeal joint, maybe give him a steroid injection. I asked my sister to get materials: lidocaine, Kenalog, a few 3-cc syringes, a few 22- and 25-gauge needles, Betadine, sterile gloves, etc. I was prepared to give my old Philippine medical license number, but there was no need. Prescriptions are superfluous in my homeland. Interestingly, I found this to be true on a recent trip to Spain as well.
But my brother-in-law got in the way of my grand and grandiose plans. As he put it, there was no way he was going to let me MacGyver his toe. While I am no stranger to office and bedside procedures, this was completely unknown to him. There was no scenario in which he was going to let me near his inflamed and tender toe in the nonsterile environment of his hotel room!
In the end we settled on getting him some oral Prednisone, again, without need of a prescription. My initial dose of 40 mg have no effect, but when I put him on 80 mg, it worked like a charm. He was able to enjoy a few more beers, sweet succulent shellfish, and the splendor and strangeness of Tokyo.
I was recently in Manila to attend a family function. While there we had quite an interesting experience that began when my brother-in-law, a previously healthy 41-year-old white male of Croatian descent, came to breakfast one morning limping. As we sat in the hotel restaurant chatting over coffee and fresh mangoes, the rheumatologist in me could not resist asking to see his foot. He promptly complied, offering up his be-flip-flopped foot for me to examine.
As my sister put it, his foot looked exactly like all the pictures of gout one finds from doing a cursory Google search. I can only imagine she meant James Gillray’s 1799 caricature of podagra. Please permit me to indulge in an aside on the significance of the mythological reference: Podagra was the spawn of Bacchus’ seduction of Venus. Fittingly, in the 18th century gout was believed to be a consequence of too much alcohol and sex.
Being the responsible, newly minted rheumatologist that I am, I wanted to crystal-prove the diagnosis. Also, my brother-in-law still had a long vacation in front of him including another 8 days in Manila and 3 in Tokyo. We all wanted him to feel better so that he could enjoy his trip. But how to do so? More to the point, how to do so in Manila, where I am an ocean and a continent away from my office, my materials, and my microscope?
Supremely confident, I thought I would proceed anyway; tap the first metatarsophalangeal joint, maybe give him a steroid injection. I asked my sister to get materials: lidocaine, Kenalog, a few 3-cc syringes, a few 22- and 25-gauge needles, Betadine, sterile gloves, etc. I was prepared to give my old Philippine medical license number, but there was no need. Prescriptions are superfluous in my homeland. Interestingly, I found this to be true on a recent trip to Spain as well.
But my brother-in-law got in the way of my grand and grandiose plans. As he put it, there was no way he was going to let me MacGyver his toe. While I am no stranger to office and bedside procedures, this was completely unknown to him. There was no scenario in which he was going to let me near his inflamed and tender toe in the nonsterile environment of his hotel room!
In the end we settled on getting him some oral Prednisone, again, without need of a prescription. My initial dose of 40 mg have no effect, but when I put him on 80 mg, it worked like a charm. He was able to enjoy a few more beers, sweet succulent shellfish, and the splendor and strangeness of Tokyo.