Clever ways to save on doctors' bills.

22 responses total.

Can anyone suggest a good material, and a source, for making my own orthopedic
shoe inserts in which an area under one heel is indented to remove pressure
on a bone spur?  The orthotics place can make them from $360 plus the cost
of a prescription and I would like to experiment on making my own first, at
least to see if it helps the problem, before spending that much.  Is there
some place to get 1/4" sheets of cork, foot-sized?  Or some sort of not very
compressible plastic or rubber that can be easily carved or smashed thinner
in one spot?  I have one pair of less-painful shoes in which there may be a
cork innersole.  Maybe 3/8" would work better?  Jim thinks auto supply places
sell cork and rubber gasket material - do hardware stores also have that?

STeve needs an insert for one foot at a very high cost.  Our GP told him to
just buy the Dr Scholl's insert. Much cheaper and can be transfered between
different pairs of shoes.  The prescription insert had to be fitted to the
shoe as well as to his foot and couldn't be transfered (and it had to be a
certain type of shoe to bring the cost up even more).  Since a pair of shoes
lasts him 2-3 months, tops, this is not an option.  Insurance will only cover
one insert per foot once every few years, not once every couple of months.

My insurance covers no inserts.  What sort of Dr. Scholl's insert?

He has a tendancy to walk on the inside edge of his feet, this causes a lot
of ankle pain and aggravates his gout.  Dr. Scholl's has a hard plastic insert
that is higher on the inside edge and has a very firm arch support.  It does
help when we remember to buy them i.e. unless the ankles hurt he doesn't think
about them or complain, when they do hurt he isn't walking let alone shopping.

Jim's brother in law has gout and there is a list of foods to avoid that
contain DNA in them - cauliflower, asparagus, other things that are growing
fast, shrimp, seeds and nuts, alcohol.  Gout is caused by accumulation of
crystals of some compound produced from nucleic acids in DNA, that the body
is not breaking down fast enough.  

Something got lost in the translation there.  Last I heard, every living
thing had DNA.

I meant 'lots of DNA'.  Cells containing a lot of starch have relatively
little DNA.

Huh?  I know that red blood cells are denucleated (but I don't know how or
why) before being put into service, but I'd never heard that about fat or
other "energy storage" cells.  If a cell has a nucleus, it has all the
DNA of any other cell of that species.

(An argument could be made that, as a percentage of volume or or mass,
'storage' cells have less DNA than some other cells, but that is probably
not relevant to the source of gout: cells are relatively small, after all.)

Make that 'lots of nucleic acids' - I know more RNA is present in growing or
replicating cells.  Cells that contain a lot of starch have relatively little
nucleic acids compared to total mass.  Growing tips of plants (asparagus) or
flower buds (cauliflower) contain more growing cells.  

In any case, last I heard (source was mid-20th-century), cause of gout was
unknown.  It is associated with a buildup of uric acid, and there was dispute
as to whether this was the cause, but (at that time) the consensus was that
it was not.  In advanced cases, uric acid crystalizes in the tissues, but the
common symptoms appear before this happens, and injecting much higher levels
of uric acid into people does not produce gout or its symptoms.

Historically, treatment by diet has been popular but not very effective. 
Again, my knowledge is some half a century old, and there may have been
progress in that time.  (I happened to run across the thing yesterday, purely
by coincidence.  Haven't pursued it.)

sodium urate precipitates in the joints and tendons, not uric acid. Uric
acid arises from the metabolism of purines, as in nucleic acids. We all
have some, but our systems keep both uric acid and sodium below the
levels necessary for precipitation. (Bird produce uric acid as the
waste product from amino acid metabolism - its the white stuff in
their droppings: humans make urea instead.)

Now linked to the Health conf. as #80.

Back to a gout-less diet shortly, but I did some online reading on heel spurs.
It may make the foot feel better to stop putting pressure on it, but the cause
of pain is not the bony spur, rather it is a tendon that is inflamed due to
too much pulling on the insertion point and if pads don't work, the web is
full of lists of other treatments.  Cortisone I can do without, but I am
trying arch supports, which prevent the tendon from pulling (it cannot stretch
out).  I generally avoid them because I have low arches and they put a lot
of pressure on the arch.  They still hurt, but I will see if they help. The
main solution seems to be to stay off my feet for a while.  I was told to bike
with the pedal under the middle of my foot (same as the arch support).

Seems like both uric acid and urate are involved in gout.  

Vegetable Juices

   Procure a juicer and make fresh juice of the following: carrots,
   cucumber, celery.
   Carrot juice is very beneficial in alkalising the blood and
   neutralising & excreting uric acid. Consume generous quantities.
   
Fruits

   The following fruits are helpful in cases of gout attacks: black
   cherries, black grapes; chew thoroughly.
   As a therapy they are very affective if consumed exclusively for
   several days until the attack subsides and symptoms disappear.
   
   
Avoid

   Avoid the following in cases of gout:
   Alcohol;
   Alcohol metabolisation produces lactic acid in the blood, increases
   the production of purine by the body and severely interferes with the
   kidneys' ability to filter and excrete uric acid. This is often enough
   to pass saturation point of uric acid in the bodily fluids and start
   the crystallisation process.
   Tobacco;
   Foods that form purine; i.e. animal derived products and in particular
   organ meat, brain, sweetbread, pate, sausages.
   These contain high levels of purine which is further broken down in
   the body into uric acid, which is the bane in gout.
   If the excretory functions are no longer able to cope with high levels
   of uric acid, it courses through the bloodstream and deposits in the
   form of urate crystals in soft tissues and in the joints' synovial
   fluids.
   The problem is accentuated by a modern, meat-based diet that produces
   acidosis in the blood. This tips the balance beyond saturation point
   and uric acid crystallises.
.....
   Overweight sufferers should reduce their weight, and aim to maintain a
   more healthy level. The adherence to a proper alimentary regimen will
   automatically achieve this and bring a plethora of health benefits
   with it.
   
[section on deer velvet and bee pollen omitted - this site is commercial]

Gout

   The uric acid level in the blood goes up in persons with gout. Alcohol
   is not recommended for persons with an elevated uric acid because it
   causes your body to lose water and may increase the uric acid levels
   in the blood. Also, foods high in purines break down in the body to
   uric acid. However, food sources of purines account for only about 50
   percent of the uric acid produced within the body. The remaining uric
   acid breaks down from other sources within the body.
   
   We used to prescribe a low purine diet, but the diet is not as
   frequently used. A low purine diet omits organ meats like liver,
   kidney, sweetbreads, brains, meat gravies and extracts, sardines,
   anchovies, herring, mackerel, scallops and most wild game. The
   following foods are allowed once per day: meat; fish; poultry; dried
   beans and peas; asparagus; mushrooms; cauliflower; spinach.
   
   High levels of uric acid increase the acidity of urine excreted by
   your kidneys. This increases the possibility of kidney stones. Fluid
   intake in the form of additional water up to two quarts per day helps
   ease the excretion of uric acid.
   

Where do you get this stuff? Carrot juice? Well-chewed black grapes? This
all sounds like witchcraft (which is a big component of "alternative
medicine"). 

The carrot juice stuff was from a website trying to sell deer antler and bee
pollen.  It was typical of what I found on the web.  Presumably people filling
up on carrots and grapes will have less room for alcohol and meat.
My brother lives on primarily a meat diet, few vegetables or fruits, and had
a kidney stone, which is related to gout (uric acid causes both of these).

In the US urinary calculi are 80% composed of calcium oxalate (stay
away from that spinach!); 5% of uric acid; 2% cystine; and the rest of
magnesium ammonium phosphate for infection residue. [Merck Manual]

The black cherries work well for STeve, either eating them or in black cherry
juice.  Will tell him about grape and carrot juice.

Stay away from an animal-based diet heavy on milk products, too.
Does cooking break down the oxalate?  Rhubarb is very high in oxalic acid -
is that what makes it sour?  So is swiss chard.

The site did not mention the chemical reasoning behind its list of fruits and
vegetables.  Maybe they make the blood more acidic?  The vitamins cannot hurt.

Oxalate is not broken down by cooking. You can remove it with bleach,
however.                     8^P

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