So I've had trouble walking for a few days, to the point where on Sunday, all I could do was lie in bed. Any sitting position not on the pillow-top bed was just too uncomfortable. Walking was quite difficult, but it took me a while to realize that it wasn't exactly that I couldn't put pressure on my right foot—it was that I couldn't really flex the ankle or foot at all, and you kind of need to do that to walk.

I called the doctor yesterday morning, and he sent me to the local hospital. Our local hospital is great, even though it's currently fighting off bone-headed bids to "reform" it, powered by a study saying such "change" was necessary to "grow" and "move forward." A community hospital does not need to "grow" more than the community does, and my community is not growing right now.

Who would think otherwise? How about a company who purchases and manages small regional hospitals in Oklahoma for its business? They're the ones who did this "study" that led the local politicians to press for "change," yet somehow this horrid conflict of interest never got mentioned in the local paper until after the pressure led both the administrator and the CFO to resign. Now, surprising no one but the city council, that same management company says finding replacements for those two will cost more than they were getting paid, while the council seemed to think they were getting overpaid.

The hospital doesn't make money, people. Neither will the ambulance. EMSA doesn't make a profit. It's a community service, like fire and police, because we need it to be there—more people will die if the closest ambulance and ER services are 20 to 35 miles away. Accept it and move on.

Anyway. I have nerve damage in my feet—they were swollen for a long time before the heart failure diagnosis, and they never quite recovered feeling. When I step on something, I don't always know it immediately. (I haven't gotten any injuries or anything, but you know how if you step on a power cord on a bare floor while barefoot you feel it? I don't.) So it was possible that I had injured my foot somehow and not known it.

Thanksgiving complicated things, because something was too high in sodium—I took the extra diuretic dose that I'm allowed to take in case of weight gain on Saturday and I shed five pounds overnight. I also have a cold-like thing, which had masked the fact that shortness of breath was partially due to that and partially due to increased fluid in the body. And I have some kind of infection on my back (like a zit) that may have complicated things, too.

So, in short, I didn't know what the hell was going on. I just knew that not being able to get from the office to home was not a sustainable situation, and I got sent to the hospital because they're the ones with the X-rays, lab, etc. Once they looked at it, though, they pretty much knew it was gout. (They've seen gout before. I, as a tech nerd, had not.)

Gout is perhaps best explained by the 22-minute educational film "Love Hurts and So Does Art," also known as King of the Hill Season 3 Episode 18. Bobby gorges himself on foods too rich in purines and develops gout.

Gout is caused by uric acid crystals forming in joints, where you really don't want crystals of anything except perhaps Magic Universal Love. Crystals + muscle or cartilage = OW. For me, it may be a sign of kidney problems caused by treating my heart problems, and that's going to be an ongoing issue. I'll see the doctor for a follow-up later in the week.

Gout is normally treatable by drugs that reduce uric acid in the blood, so it can't build up and form crystals. The generic name for the most common one is allopurinol. I'm still reluctant to reveal too much about myself because people have made me regret it in the past, but allopurinol was the medication referred to here that generated an "adverse reaction." I described it to my doctors as like "soaking in a tub full of arthritis."

See, here's the deal:

• I'm still on diuretics to help me keep off water weight, because congestive heart failure means that my body will want to pack on extra fluids unless it's told medically not to do so. I'm on lower doses than before, but not zero dosage. A zero dosage is possible, but there's a complication.

• Allopurinol is contraindicated with the diuretic I take. In fact, the combination actually increases uric acid in the bloodstream. This, in effect, gave me gout at the end of January, and it's why I couldn't straighten my knee. It wasn't a reaction to allopurinol so much as to allopurinol with medicine I was (and still am) taking.

• The other common treatment for gout is steroids, or non-steroidal anti-inflammatory drugs (NSAIDs). You can't stay on steroids long, and NSAIDs may be bad for my kidneys, so I've been off them for nearly a year. Like 11.5 months.

So if I have to take allopurinol to reduce the uric acid levels, I probably have to stop taking the diuretic. I would gain some weight but I could probably manage that. The real problem, for me, is the dietary change.

Now, most Americans can manage problems like gout (and diabetes, of course, and even make significant contributions to managing heart disease) through dietary changes—and most Americans are absolutely unwilling to do this. It's true that some are unable: you've seen me rail on here before about how freaking hard it is to keep a low-sodium diet when everything at the grocery store, including things you think of as "ingredients," is filled with sodium—usually salt, but sometimes MSG or baking powder/soda as leaveners in cookies and such.

With gout, though, it's not so complicated. Foods high in purines help contribute to higher uric acid. There are pretty clear lists of foods you should avoid if you have gout, and less clear lists of foods you should eat if you have gout.

I can handle the purines. I don't eat a lot of the foods to avoid anyway because most of the ones listed there are incredibly salty, too. The seafoods aren't, but the salmon comes with Omega-3 fatty acids that are good for gout, so it's kind of neutral if you don't eat it every day, and I don't (I don't live near an ocean).

The problem for me is the diuretic.

Heart patients on diuretics to reduce sodium usually have to take potassium supplements because the diuretic flushes potassium as well. Potassium is good. You need it, and should get more of it than sodium, but not too much. After reducing the diuretic, I was getting too much potassium, so I cut out the supplements.

Where was my extra potassium coming from, if I wasn't taking a supplement but was still taking diuretics? Salt substitutes are all potassium chloride, the only thing safe (in moderation) that tastes anything like salt. They're far from perfect—salty foods just taste "salty," but foods with too much KCl taste bitter. But foods without any salt or substitutes taste like cardboard. I tried for several months, I know.

If I have to stop taking the diuretic, it is possible that the salt substitutes will contribute too much potassium to my diet, without the diuretic flushing potassium out with sodium. That would likely mean cutting back or eliminating those as well, and that pretty much makes all foods for the rest of my life drab and tasteless.

I've tried to be a good soldier about my illnesses. I've done the low-sodium diet, every day, tracking it all, and I think it's a significant reason why I've not only lost 100 pounds in two years but also restored my heart function nearly to normal. It means I cook most of my own food, and have all but given up things like Chinese food and eating out. I can avoid the foods on the gout list, and I can even exercise when I get all the kinks worked out.

But facing a lifetime of bland foods scares the crap out of me, almost as much as a life of the kind of pain I had yesterday. I'm going to work with the doctors as much as possible to make sure I don't have to switch to subsistence off Soylent Green, but it's worrying me, I can tell you that much.

I'll be on light duty this week and on a "sane person's" schedule (that is, awake in the mornings and sleeping overnight) to get the doctor stuff worked out.