Get up and walk, Ignacio

Ignacio appeared to be in pain as he was pushed by wheelchair into Room 16. Pulling his pantleg up it was clear why. His right knee was about twice the normal size, and tender to touch. Apparently he had been in the urgent care center over the weekend and had fluid aspirated from the knee to look for bacteria and crystals. Because he had had an episode of gout before, gout was the number one likelihood as the cause. But two things bothered me, first that he had no crystals in the fluid, and second, Ignacio is not a completely straight shooter. By that I mean he has a long history of drug addiction, and that means he could have a septic joint, infected by bacteria that happen to get in the body by dirty needles and then take up residence on the heart valves. Also, I have to think about gonorrhea, which can also migrate from the genital area to the knee if not treated. Fortunately, fluid had been sent for the proper analysis on Saturday and there was no sign of infection. I prepared his knee with iodine and then stuck a long needle into the center of his knee, aiming just under the kneecap. Within 5 minutes the local anesthetic was beginning to take effect and his complaints had settled down. He was able to get up and walk out of the room. There's not much more dramatically effective than an injection of steroid and lidocaine for someone suffering from an attack of gout. Next week we'll try to address the alcohol abuse and heavy seafood that probably triggered the attack.