Hello everyone, I hope you're doing well. I (21, 216 lb, 5'8") have been having join pain for almost 2 years now.
I first noticed it in my left knee but later I started having pain in all of my body. Right now I could get pain in my ankles, knees, hips, neck, shoulders and elbows. The pain comes and goes seemingly randomly and with varying degrees (some days it's bearable and other I can't walk/use the part that's affected).
I have been to 2 orthopedic surgeons and a rheumatologist, conducted multiple MRIs and blood tests. So far everything seems normal except a miniscus tear in my left knee. The MRIs show no signs of damage or arthritis, I asked about gout as well but my uric acid levels are normal and my MRIs don't show any crystals on my joints.
Some things I've noticed us that some of my joints are hypermobile and the Ortho surgeon said my left knee is hypermobile and has a derangement. Another thing is that when I eat processed or overly sweet/fatty food like fries, fried food, instant noodles, sausage, etc. my joints feel very achy within a couple hours and in some cases I'd be in very bad shape the next day. I've been cutting food from outside and mostly eat home cooked meals and find the pain has greatly reduced.
I have been prescribed with celebrex so far but nothing else is being done because doctors can't find anything. What should I do?
Thank you.

On behalf of my husband
28M 6'1" and about 250lbs
Caucasian, drinks 2-3x/week (wine) and smokes weed daily. No medication.
Canada
My husband has always struggled with his weight since he was 21ish (slowly gained over years, has had difficulty losing weight but was successful last year about 40lbs, he has gained some back since though). I have over the last few years suspected possible insulin resistance or some version of prediabetes? Its not something I know a lot about but we have had suspicion there is some underlying issue going on that he has been dealing with over the years. He delt with diverticulitis briefly in 2022 as well.
I would describe him as tired often, sore often, gets very irritable when hungry and occasionally light headed. He fasts all morning and usually doesn't eat until 2pm, I would say he snacks after that but overall does not eat crazy amounts of food, I eat the same as him usually but he still struggles with weight. When he was heavier in the past he used to sweat so much after dinner and his face would get red and hot but this doesn't happen anymore.
Now he has the last few months been dealing with a very very painful big toe joint, he can walk but is careful not to bump his toe and says it hurts when the bed sheets rub against it. It has been getting worse, I have noticed he is talking about the pain often now. Can this be gout and can it progress slowly?
Ultimately what i am asking is, if we are concerned about possible gout or insulin levels should he ask for a blood test for:

• Insulin levels
  
• Glucose levels
  
• A1C test
  
• High blood sugar
  
• Uric Acid levels
  

Excuse me if those are all the same thing...i obviously don't know a lot about this but I am just trying to gather as much information as I can before he goes in to get tested. Is there anything else he should bring up to a doctor that might help us understand what he might be dealing with?
Thank you for your time.

I started Wegovy 3 months ago (starting my 4th month now).
What really forced me to do something (besides being uncomfortably overweight) was on 2/12 I did my quarterly check in with my Rheumatologist (I am monitoring my uric acid levels as I have gout) and I weighed in at a hefty 387 lbs. A few weeks later I began Wegovy at around the same weight.
3 months in and I'm down nearly 40 pounds and actually wore a shirt I haven't been able to wear in a few years recently.
I'm really hoping once I get to where I want and can start truly exercising I'll drop the shot and let that take over.
I've made quite a few lifestyle adjustments including: drinking mostly water (this cut out a lot of sugar intake I had from drinking sweet tea), only milk in my coffee and cutting that back to a day or two a week vs nearly every day, eating less, eating healthier by staying away from fast food (Mcds, pizza, Chinese, etc) and cooking more at home, adding more walking into my weekly life, and I feel great. I'm grilling out several nights a week which includes grilling vegetables that we have as our side. Quick, easy, and delicious. Fish, chicken, steak. All good stuff to throw on the grill!
These are all things I used to do when I was fit. But lower body issues and bad eating habits caused me to gain nearly 160+ pounds.
Only 125-130 more to go :)
Keep at it, friends!

• Age: 29
• Sex: F
• Height: 170cm
• Weight: Not known, but "absolutely fine" according to the nurse I saw last week
• Race: White
• Location: UK
• Medications: Currently using NuvaRing for contraception and Soprobec/Salbutamol inhalers for asthma, though these have been more recent than my issue
• Other medical issues: Chronic fatigue syndrome
• Duration of complaint: ~5 years, worse in the last 18 months

I started developing what feel very much like gout symptoms about five years ago. I woke up in the middle of the night with excruciating pain in my big right toe, which felt like it was extending from the distal phalanx joint forwards towards the end of my nail. It felt hot, and the painful part of my toe was red (not sure if it was swollen or not). It was bad enough to stop me from sleeping, and once the pain subsided, my toe felt "off" a bit for a day or two afterwards.
I would get similar attacks maybe every 6 months - 1 year since then until about 18 months ago, when the frequency of them increased. I now get them every month - 3 months. It's been about a year since I first contacted my GP about them, and last week was the first time I saw a rheumatologist about these issues. I haven't spotted any pattern between these flares and food or exercise.
Tests done over that time:

• Bloods: multiple times, all fine (in particular, no raise in uric acid levels)
• X-Ray, about 8 months ago: all fine
• Ultrasound, last week: some fluid spotted on my joint, but no signs of inflammation

I have no history of breaks or injuries to that toe. My mobility in that joint is now limited compared to my other foot, and I experience some pain when that part of my foot (including my nail) is pressed firmly (also compared to my other foot).
The rheumatologist said that he could rule out gout, psuedogout or rheumatoid arthritis from all of these, and is going to refer me to a foot surgeon. At this point, I'm at a loss as to what this could be. Having just had another unpleasant night of little sleep (which I think was possibly caused by the ultrasound itself and all of the moving around), and waiting lists being lengthy, is there anything else I should be looking into to relieve the pain, reduce the frequency of these attacks or otherwise just have some idea about what this might be?

My mum and dad split around a year ago, and even though it was bad before it's getting worse. Over this time it has become apparent to me that it was always our dad taking care of us (me, my sister and my two younger brothers), and never our mum. My grandparents, on my mums side, are urging me to go to a counsellor at school, but I don't know if what she is doing is really that bad. Our youngest brother, 10, has ASD (autism). He is diagnosed, and is nonverbal. Me and my other brother, 12, are likely autistic too, but she has no intention of getting either of us diagnosed. What concerns my nan is that she says our mum is neglecting us medically. I told her that one of the last times I had been to a doctor was when I was 11. That was because my mother thought I had gout due to me complaining of pain very often. We went for one appointment, had a blood test, and she had never taken me back, despite getting results that it wasn't gout due to a lack of what causes it in my bloodstream. After a lot of research, I believe I have fibromyalgia, or something simular as I relate to many of its symptoms. My pain has not gotten better, and she has made no moves to help me with this. She will now laugh it off when I complain of pain, even though I'm sure she believes me. It is getting very hard to deal with, which is what made me mention it to my grandparents in the first place. My right ankle will also lock up if I walk for 20mins. What I did not mention is that I have had thoughts of ending it because I don't think I can live like this. But every time my mum laughs it off, I can't help but feel that maybe I'm overreacting? We talked more; me, my sister, and my nan, and my sister, who hasnt lived with us for ~6 months, mentioned other things. Since our parents seperated, it has been me, 19(sister) and 12(brother) cleaning the entire house. I will be called downstairs, no matter how much my body ached, to open the door for a cat often. While she is sitting in an armchair on her phone. She (my mum) said because we are younger we can do more. Despite her adopting all four of our cats, she will never feed them. It is always me. I will be called down to clean the kitchen, the lounge, every mess her and 10 make, I am made to clean it. She will say to her friends she only had us to do her work and make her rich, and though everyone takes it as a joke, I don't think it is. My sister moved out because she was doing this work too, and was still expected to 'pay board' to my mother.
She will ignore us if we say anything to her, and if we continue to try she will yell at us. 12 has been yelled at for telling our mother that 10's seatbelt had been unbuckled. I remember my mum threatening to throw a kitchen knife at me if I didn't shut up. She does not remember this, and when i insisted on her saying that to me, she said she probably didn't mean it anyway. I don't know why, but that really sticks with me.
I am expected to look after 10 whenever she needs me too. I likely have ASD, and to be well emotionally I need to prepare myself for it. I have received no notice before; just a text she was going for a coffee and that 10 was home. She says I can say no any time, but I have once since I was sick and she yelled at me for being so selfish. She wanted to take 12 out for a dinner somewhere.
Even though there is food at home most of the time, she is never there for us emotionally. It doesn't effect me so much; I'm old enough to be independent, but she does not pay frequent attention to 12. I believe this is a reason for his anger issues, he can not talk out his emotions and if he attempts too he will be yelled at. As much as I wish to be, I am not mentally well enough to help him.
I'm sorry if this is a mess. Im just typing this to try and earn the courage to talk to a counsellor. I have no clue how it works, and I'm scared of it. Does anyone have anything to help with a counselling session?

Went to the ER yesterday with an extremely swollen and painful ankle. At first I thought it was a blood clot as I got off an extremely long flight but an ultrasound proved otherwise. The ER doctor looked at my ankle and said she was pretty sure it was gout and that she didn’t recommend the fluid test. She prescribed some indomethicin and prednisone and sent me on my way.
As a 21M I’m a little confused about this whole situation and what to do moving forward. This subreddit has been very helpful in terms of information but I had a few questions.
Should I start limiting my diet fully? (A bummer to a college student who does drink regularly, but will do what I need to do to maintain my health)
Or should I test for foods that trigger for me?
For some reason my ER doc didn’t request a UA test in the bloodwork, so my other question is how long after this flare subsides can I get an accurate UA reading?
Also I know Allo isn’t prescribed til a second flare, so should I wait (hopefully it never comes) for a second flare til I see a rheumatologist and get their help?
Thank you guys for your help, as a pretty young male I’m a little confused and off put by all of this

Hi guys. I am seeking some advice. TLDR at the end.
Last month, I had a heavy night of drinking and woke up the next day with some discomfort in my toe joints. Nothing unbearable, but definitely not normal. I took some ibuprofens, which helped, and went on with my day. The pain persisted for a few days, then went away.
Having a history of high UA, I suspected I might have gout. But I wasn’t sure because I didn’t have the traditional symptoms of a gout attack and the pain wasn’t all that severe.
Anyways, I visited my home country recently and went to see a specialist. He checked my UA level (8.1 mg/dL) and took some X-rays. The x-rays do not show any visible signs of gout crystals.
The doctor, who also has gout, said said I “most likely” have gout based on my UA and my “warning signs” symptoms. But since I have never had a full blown attack and does not have visible signs from the x-rays, he will not diagnose me with gout just yet. He did say that my experience is extremely similar to his own, and gave me lots of advice of food moderation.
Now, I asked him about Allo as a preventative measure. He said I can take it, but there can be some side effect on the liver, which he himself has experience. His advice was that since I am not yet “100%” diagnosed, I should focus on food moderation for now. He did prescribed me with Colchicine and Celebrex to manage possible attacks. He would have prescribed me with Allo if I asked, but I wasn’t sure.
Now, I paranoid about eating anything and triggering an attack. It’s starting to affect my mental health. But I also do not want to put unnecessary burden on my liver.
TLDR So here is my question. Since I have not yet been diagnosed with gout and never had an attack, should I be taking Allo to maintain my UA? Is it worth the side effects?
Appreciate any advice or personal experience you want to share.

Started bp stack and ordered premade super veggies, but I'm really struggling to eat the super veggies. Any tips?
I find nutty pudding easy and enjoyable, especially mixed with almond milk and blueberries in the morning. I follow it up with a shot of extra virgin olive oil and my usual supplements. I skip red yeast rice due to a possible allergy.
Do you think I should add NMN, Metformin, or Berberine to my regimen?
I haven't been using the longevity mix because of my concern with creatine, given my gout issues/uric acid.
Hoping this diet will help resolve my health problems.
Also, the super veggies taste like lentil and ginger baby food mush (not a fan). I’d rather have a steak, but my gout says otherwise.
Another challenge is avoiding late-night snacks and staying up too late—I'm a night owl. I've been taking 300 mcg of extended-release melatonin, but it doesn’t seem strong enough.
Any advice or suggestions would be appreciated. Help! 🆘🆘

The results are in for Match 21. The winner is…
Mahimit was dragged across the battlefield by ｢Young Lives｣, the Stand filling him with a vigor to fight, to please his father who was watching from above—and that vigor filled him with each slash of its claws, keeping the son awake as he was marched down towards the trailer.
The two Stand Users had made their way down there last—secluded within a small container, cornered. The Stand’s puppet had been worn down for certain, but this was the time to finally finish things. As they approached, they saw through the window the older woman pull out her phone, and immediately Mahimit’s arm was raised to aim his gun right for it. As they made him pull the trigger, he couldn’t fire before she had spoken to her allies on the other end:
“Yeah, we figured out who the perp is, it’s Thomas Kent. Singh didn’t even show up, sent a lackey instead. He should be…”
The rest of her sentence faded out as Mahimit stalled…stopped.
The Stand roared in panicked fury as its user lowered his gun, unable to control them with the ease it once had. Mahi barely noticed—neither did they react to Windy’s warm, draining embrace of as ｢Young Lives｣ attempted to claw her off of him. As his eyes began to close, the longcoat of his Stand’s prior form disappeared and revealed the real one beneath, he managed one thought before falling into a deep sleep.
Of course he didn’t. Why did I think otherwise…

Sonika Singha and Windy, with a score of 72 to Mahimit “Hira” Rākin’s 56!

Category	Winner	Point Totals	Comments
Popularity	Sonika Singha and Windy	27 (14+2) - 3 (0+2)	A shutout victory for the players!
Quality	Mahimit “Hira” Rākin	17 (6 5 6) - 20 (7 7 6)	Reasoning
JoJolity	Mahimit “Hira” Rākin	18 (6 6 6) - 23 (8 7 8)	Reasoning
Conduct	Tie	10-10	Nothing to report!

The results are in for Match 22. The winner is…
Club Naraka, the site of a hellish pile of bodies and accidents, was practically on fire that night. Thankfully, Sulka, along with a group of armed guards, had brought a fire extinguisher with them. They stormed the ground floor, taking a moment to spread themselves out. “Alright, we’ve-” A hail of gunfire cut the man off. “—THEY’RE HERE!”
A few of the nameless guards rushed in towards Sulka, to catch any strays that might come his way. Sulka himself pulled the nozzle end up, and heard another single shot fire from another nearby pillar. “There’s an accomplice, circle—” Something crawled up his thumb, and bit into the extinguisher, just as a stray bullet drove a dent into the metal casing. “—AUGH!”
The fire extinguisher burst in his hands, filling the room with a heavy white smog. The hip-firing moved, and it came long, low, and in mobile spurts. “Fire back—” As if on cue, fire jettisoned into the cloud of smoke, “—SPREAD OUT, QUICK!” Through blurred vision, Sulka watched one of their own leave through the front door. “Not that far, damnit!”
With the guards spread out along the floor around him, some wearing gouts of fire, some drenched in the liquid refuse of their extinguisher, and others still riddled with bullets, Sulka turned to one of their dead men, and ripped a pistol from their side. They watched the last moving object head for the door, and pulled the trigger, twice. An employee badge caught the edge of his blurred vision.
The cool night air filled the ground floor, and fed the flames atop the burning men. Sulka’s arm fell to his side, letting the gun clatter against the floor.
A spiral of thoughts took him. First, he’d need to make a casualty report, followed by a loss statement. The sheer number of clients who may not come back after an incident like this would likely drive the place out of business. Between that, the viscera, the dead workers, the dead clients, and all the ammunition costs—let alone the licenses he’d have to put in for—his head shrieked at him. For once, he shrieked back.
It was a low, horrid thing, much like a growl or snarl, but loud enough to make itself known against the billowing call of night. A cool hand slicked his hair back, and the night air stopped pouring in through the shutting door. He turned to one of the guards, who’d taken to putting out another with a blanket. “Take everyone alive and go look for everyone else alive.” Sulka sauntered away. “I’ll be in my office.”

Reese McGuffin, with a score of 72 to Markov's 69!

Category	Winner	Point Totals	Comments
Popularity	Reese McGuffin	13 (3+2+2) - 17 (5+2+2)	An even voting period right up until the very end!
Quality	Markov	23 (7 8 8) - 22 (7 8 7)	Reasoning
JoJolity	Tie	23 (8 8 7) - 23 (7 8 8)	Reasoning
Conduct	Tie	10-10	Nothing to report!

Somewhere in the night, a Club Naraka coat and hat, usually only worn by guards, lay in a trash can. A woman, caked in blood and all manner of horrors, pressed herself against the wall beside it, and fished through her pocket for a coin. She’d found it there, in the elevator, on her way to her shift. Moonlight danced across its surface, letting the coin shimmer madly in the low light. ”Hah… you… y-you saved me…” Emile was shuddering, clutching the golden coin tight, for fear of dropping it. “I-I don’t know why, but… w-whatever you want of me, I’ll gladly give it in return… p-please, tell me…who…who are you?”
“…aha!” the voice chuckled. “How…terrible of me! In all the commotion, our…introductions com-pletely slipped my…mind.”
The air in front of Emile began to shift and shimmer. As she pulled her gaze away from the coin, she saw something phase into existence—a feminine form, long purple wires for hair, and a peering red eye gazing back at her beneath them.
It was the most beautiful thing she’d ever seen.
“My name is Markov. And your ad-mir-a-tion is payment…enough.”
Emile stared, gazing in wonderment at the hovering figure. Whether from exhaustion or reverence, she dropped to her knees, tears beginning to streak down her face. She thought of the ordeals she’d just faced. The people she’d passed. The people she’d fled. The people she’d killed. There was something else, though—the figure’s eyes seemed to- “That…hole in your shoulder.” Emile’s own head turned to match the figure’s gaze. “Do not fret. I can…teach you how to…take care of that.”
From the roof above the pair’s heads, one couldn’t hear the quiet murmurs and shivers of a woman ripping apart her own viscera-caked clothes to seal her wounds. Other things were certainly on the mind of its occupant, one Reese McGuffin.
Before him were two rats. Before them was a whole litany of ghostly creatures. His hand pointed towards the rat to his right, “Alright everyone, this is Splinter—” before it moved to point at the rat on his left, “—and this is Remy!”
Remy waddled up to a Utahraptor first, and started sniffing at it. “Oh, lemme introduce you to pieces, Remy!” Reese put a hand between the ghost animals, and casually shuffled it back and forth as he spoke. “Remy, Pieces! Pieces, Remy!” He turned on his heel to see Splinter eyeing up Finn, the shark. “Hey! He’s a friend, not food!”
A comforting quiet filled the night air as the ghostly animals circled one another, introducing themselves in their own little ways. The only thing left on Reese’s mind was a single odd question, one that had been eating at him since he left. “Where did I put that coral?”
Slowly, Mahimit awoke to the morning sun’s light. They could have sworn that they had a nightmare that night, but they felt refreshed as if waking from a peaceful slumber…
That wasn’t a nightmare, was it? He thought he could manage it all but in the end he just…broke as soon as he saw Ajay lying there with a bullet through his shoulder—wait, is he okay? Was he brought to safety? Did the Suite now think he was involved?
“Hey, don’t worry—you're safe here.”
Mahimit blinked, finally taking note of their surroundings. They were lying in a plain white bed, first aid boxes and equipment scattered about—the architect remembered the claws raking at their back throughout the night. Their torso had been bandaged up thoroughly: their long coat was laid out across a table, while their shirt was currently in Windy’s hands, who must have paused in stitching back up one of the tears when she noticed them awake.
“W-where am I?” Mahi asked. “Is Ajay safe? Where is he?”
“Jon got him to a hospital as soon as he could,” a voice called out from the door. Mahi looked over to see who looked like a detective walking in, followed by the two he recognised having gone after Zafar back then—no, not Zafar. “Had to be more careful with you given how well known you are, Mahimit—or do you prefer Hira?”
The architect sighed with some relief at that, not finding any deceit in the answer. “Either’s fine…not sure which one’s more ‘me’ anyways.” He looked around at the group settling into the room. “…Where’s the other person who was with you? Is she okay?”
A silence filled the room as the four recalled what Windy recounted once they regrouped—Sonika had lost hope, and ended up attempting to kill an unconscious Mahimit before she was stopped by Windy which caused the PI to run off.
Steric didn’t look it, but he was probably one of the most affected within PINDROP. While diving into his work wasn’t the healthiest coping mechanism, he had been increasingly concerned for Sonika’s health and disposition—so to hear that she not only ran off, but wanted to dispand PINDROP was crushing. “She…she ended up leaving.” He refocused onto Mahimit. “You said you’re unsure about yourself—would you be willing to answer why?”
Hira chuckled. “I guess I do owe you some answers. Well, I first went out as ‘Hira’ right around when I manifested my Stand—but then I ended up going out as them more often. Started to look into stuff about myself without the pressure of being the perfect son on my back…haven’t felt I’ve had the chance to really do so since I came back to Rakin.”
“Because of Zafar?” Inago asked, taking a nearby seat. “You don’t have to answer more than you’re comfortable with, but…you only went berserk after you thought he had just shot your friend.”
“Yup,” Windy nodded, setting aside the shirt and needle. “And I couldn’t help but notice ya stopped letting that Stand control ya once Sonika said out loud that it wasn’t your pa.”
Mahi winced. “…Yeah, I thought it was Zafar. He was a great parent and I never wanted to let him down, but things got so out of hand that when that last piece dropped I just…shattered, I guess. Though even if he was told it probably wouldn’t matter…”
“And why’s that?” Steric asked, jotting down some notes.
“He’s stubborn, sticks to how he thinks things are. If anything challenges his view on a friend or ally of his, he’ll just ignore it and carry on. He’s going to learn that I was Tamas and he’ll shrug it off and forget about it, as usual. Probably the sole reason he’s still in the Metro is because he truly believes that they’re doing what’s best for the city—something I found quickly wasn’t the case.”
Drippy stepped forward. “About that: why were you in there in the first place, and for how long? And what do you know about the Middleman?”
“…I can’t tell you anything about them.” Hira spoke, eyes glancing away from her.
“W-why!?” Drippy almost yelled out. “What reason do you all possibly have to not want them stopped?!”
“Well, you plan on killing them once you know, aren’t you?”
“Yes! Perhaps if you actually told us then maybe we could see why we shouldn’t put down this person taking utmost glee in murder. I don’t get why you and Rasna are willing to protect this guy.”
“…Trust me, if I could have stopped them I would have years ago. But if Rasna’s refused to tell you, you should be able to figure out why, right?”
“…they’ve suffered a lot, haven’t they?” Inago asked somberly. “That must be why they’re how they are today.”
“Oh, so they can get off free after everything they did?” Drippy retorted.
Steric put his hands between the two lest things escalated. “We can discuss this later—at the very least that is a lead.” He turned to the guest. “As for the other questions?”
Mahi nodded. “It was a month or two after I began working towards getting into the City Planning Board. Things weren’t looking as good as I hoped, when my father decided to bring me down to see these friends of his. I was offered a deal: they would pull some strings to help get me onto the board as long as I was willing to put forward some things they wanted…even then I figured something was off, but if it meant I could help this city I thought it was worth it. Oh how wrong I was…”
Steric sighed, finishing up with his notepad before putting away his pen. “I think that will be all then…thank you for your time. We’ll leave you to rest now.”
Inago followed the PINDROP members out, looking over his shoulder one last time: “Before I forget, anything you want for breakfast?”
Mahi thought for a moment. “Pancakes?”
Windy hopped off her chair and walked closer to Hira. “You’re a kind soul deep down, aren’t ya? Even as violent as you were, ya never tried to kill anyone…”
“But I just tried to kill you! It wasn’t me but it was born from me…messed with my thoughts as well as my body. So glad my therapist is a Stand user, thank fu—dge.”
She chuckled at the self-censorship. “But you fought back in the end, didn’t ya? I think I understand the feeling of getting puppeted though, and I know Luna and Alex should be able to help with the memory stuff. If you ever want to talk about it, feel free—we’d be happy to.”
“Sure,” Mahi nodded, lying back down into the bed as they allowed themself to smile. “…Thank you.”
Scenario: Verve Residence, Sapatibhatt — 10:23AM
Clink.
The teacup rattled against the table, empty. Idly, Gioia Arancini glanced over the lid, curious to see the shape of her future reflected in the tea leaves. She didn’t believe in that stuff, but Fate had taken stranger forms. Besides, Evergreen had done a lot these past few weeks. She couldn’t help but wonder…
“You were right, Gioia!” Soichi piped up from beside her, sipping on his own cup, “this is really good!”
In front of them, Vasant Verve sheepishly wrung his hands, giving them both a little smile. “I’m glad I haven’t lost my touch, haha…! It really is the least I can do, while you’re here.”
They could not meet at Urban Hymns, as the estate had been closed since Gioia and Charvet fought the man a few weeks prior. Though she had expected the two of them would get arrested, Verve himself had told the authorities that he would not press charges. In return, Gioia had been checking in with him, making sure he was back on his feet, and that ｢Cage The Elephant｣ was well and truly gone.
“Mm,” Gioia nodded, “give Vasudha my thanks as well,”
“No problem, dear!” a woman shouted from another room. Verve had little desire to return to his cabin, so in the meantime he was staying in his younger sister’s house.
For a moment, there was silence. Verve was perfectly still, as if one wrong move would shatter this tenuous peace. Soichi was content to drink in the cozy atmosphere. Gioia was staring at the tea leaves. What shape did they form?

The peace on Mount Parapollah was just as tenuous. Muuru had returned to the mountain now that the sand worms slumbered and the shifting had stopped. There was once a being who was to the Mountain as Muuru was to the City. The being was gone, now, and the Suite was filling in the gaps with trucks and bulldozers. As Muuru watched, a woman with a flute sat down beside him and smiled. Whatever happened next, the Mountain and the City moved together.

Gioia was drawn back to reality as Soichi spoke. “So, what have you been doing during your time off?”
“Oh?” Verve blinked. “Not much, I suppose! Just some odd jobs, here and there, mostly in the South. Just trying to help the rebuilding efforts, you know? Fix what I broke.” He grimaced a moment, before deflecting back to Soichi.
“What about you? It’s usually just Gioia checking in, I haven’t seen you since, you know…”
“The whole New York thing?” Soichi chuckled. “I’ve been alright, yeah. As rough as it was, we ended up making friends with those Riders! Sometimes you need an unlikely situation to help you come together, you know?”
Evergreen had certainly faced unlikely situations before. Gioia mused on this as she looked at the leaves.

The flute was not the only instrument that echoed through Rakin. As Deacon Blues wandered through the Sapatibhatt, the song of his trumpet followed behind. The land, once torn apart, was being rebuilt. The scars from his battle with the weaponsmith were fading, but the man still taught him a valuable lesson. The hand that wields a weapon can also wield a tool. Maybe this was the nature of potential. Whatever it was, Deacon figured it was worth a song.

Gioia glanced up from the cup, giving Verve a smirk. “Tough times help you realize who your real friends are. You’ve realized that too, I’m sure. Thanks to our efforts, the Metropolis Suite is having a tough time of their own. I wonder how quickly they’ll turn on each other?”
“Xen was already convinced they were out to get him. He kept going on about this Stand, ｢Diamond Life｣. No matter what he did for the Suite, it never told him who its user was. It drove him crazy–I think he was trying to solve that one himself.”
“Did he succeed?”
“I don’t think so. It’s not like he could strike a deal with The Gossip, he didn’t have anything ｢She｣ wanted. I’m sure that drove him crazy too.” There was still a sorrow in his voice.
“Hey, it’s okay,” Soichi smiled quietly, patting the man on the arm. Gioia nodded in turn, before she continued.
“Have you had any contact with him?”
“Not really. His assistant texted me, apparently the folks at Hymnal are on indefinite paid leave, until I figure out what to do. I guess that’s on me.” Verve paused a moment, grimacing. “Apparently he might still be at the cottage? I don’t know—I’m not going to—I’m not ready to talk to him, yet.”
“You don’t ever have to talk to him again,” Gioia responded. “I’m sure he’s cowering in the dark now that we’ve exposed his true nature. The other members of Metropolis should realize they’re soon to follow.”
Indeed, the members of Evergreen might not have the same methods…but they were united in this cause. Would this define their future? Gioia glanced over at the tea leaves.

The immortal had lived through countless riots, but the Bedtown Takeover was one of his favorites. He had returned to the area, replaying his grand speech, looking at the bloodstains that marked this territory. Sure, now that Aco’s child had appeared, VULTURE was considering new leadership. But that didn’t matter to Ouroboros, content to remain the (Self-Appointed) Secret Lord of Bedtown. Behind him, Honeydew was simply content to dismantle car batteries.

Gioia glanced back at Verve to see his brow furrowed.
“I can’t believe I ever got involved with those bastards,” he scowled. “Deep down, I knew they were trouble—I talked to Xen about Sing Now!, he just said…sometimes the only way to reach a common goal is to work with people you don’t agree with. He almost made it make sense.”
“He was a smooth-talking control freak. I’m sure you’ve realized how empty those words were.”
Verve rested his chin in his hand, staring into his own empty cup. In the end, all he saw were scattered leaves. No one was guiding him now. No one but himself. “…That’s not all he was. I think he really believed it, you know? That he was doing good. I wanted to believe it too, more than anything. But I think he was just trying to justify it to himself. Even when he had his doubts.”
Gioia curled her fingers around the teacup. “What about you, Verve? What do you think ‘good’ is?”
At this, the man laughed bittersweetly. “You think I can answer that? I thought Xen had the answer, and look where that got us. If you think you’re the only guy who can change the world, you’ll just make it worse.”
He looked up at Soichi. “We saw what his world looks like,” then to Gioia, “he would have trapped us both inside, if not for you.”
It seemed the Suite had a lot of cities within cities, living symbols of their control. Gioia took one last look at the symbol in her cup.

Disco D Lune had been keeping up with her contacts at the military base, catching up with the most recent happenings. Apparently, there had been a falling-out between the general and his child: an opportunity to sew doubt and dissent amongst the ranks. Disco had already designed new buildings to replace this one, and they were beautiful.

“You’re a free man, Verve,” Gioia concluded, staring him down. “So what will you do with that freedom?”
Verve looked between the two, but found no answers. Now, his choices were his own. In the end, the answer was simple.
“…I want to make things right. The Suite they… they ruined my home, they ruined him, they ruined me. I’m tired of seeing kids get pulled into this. Rasna, Ichi, and now poor Mahamit…” Behind him, warm air sang with the soft trumpet of ｢Bitter Sweet Symphony｣. “It needs to end. Those kids, my nieces, all of them, all of us. We all need a city that we can call home.”
Gioia smiled, closing her eyes contentedly as she felt the heat roll over her. Beside her, she could feel Soichi resting a hand on her shoulder. She didn’t even need to see his smile to feel its warmth. She didn’t need to see the leaves to know the shape of her future. She had known many homes, many stories, many tragedies and triumphs. But right now, home was a tree, Evergreen. Seasons changed, and yet its leaves would always flourish.
Soichi glanced at the cup in her stead. To him, the leaves just seemed like a weird square. But soon that shape was washed away, as he poured them all another cup of warm and fragrant tea.
“Well said! This calls for a toast. To new friends!”
Clink!

Scenario: Hymnal Bazaar, Reshmerasta — 8:58 PM
The market was closed for the evening. This curfew was in place ever since the Middleman attacked. The Bazaar was already struggling—if people were too scared to walk around at night, then why bother staying open? Even when the Bazaar was open, the stall for Urban Hymns stood empty. But for a broom, only a lone figure stood there. Verve used to sweep while his employees handled everything else.
His boyfriend once asked him why he did that.
’It makes me feel like I’m doing something–” he had laughed, “I’m leaving this place better than I found it!’
Verve had a lovely laugh, the figure recalled, staring at the broom.
Slowly, he knelt down to pick it up.
Then, Xenagoras took a deep breath,
and swept the streets that he used to own.

Scenario: ???, ??? — 9:07 PM
“It’s simple, gentlemen…”
The sound of chatter and slow music. The smell of pristine tobacco and the clinking of glasses. This outlined the leadership of the Metropolis Suite, holed up in a skyscraper that overlooked the whole of Rakin. To their right, a window—one that replaced the whole wall, showing the nighttime lights. It almost looked like an alien world, the way the dark purples and reds of the late sunset stretched across the blinking gleams of windows and signs. A single man spoke, an esteemed guest trying his best to rise in their ranks: Luiviton.
“With a little bit of push, we could completely criminalize a number of traffic violations. Of course, they’re already illegal—but I’m talking perfect driving. Instead of community service, we give fines that cut chunks out of bank accounts. Instead of towing cars, we give jail time. I have contacts in the private prison industry who would be willing to pay us good money to multiply the conviction rates~! All it takes is a little bit of sacrifice from Rakin’s people.”
The table was silent. A voice piped up- that of Sing Now!, media conglomerate CEO and one of the Suite’s primary figures of authority. “That’s an awful idea, Luiviton.”
He blanched. “E-Excuse me?” He asked, flabbergasted. “We could stand to gain-”
Sing Now! interrupted him swiftly and curtly. “It doesn’t matter how much we ‘stand to gain’ from selling our city’s soul to prison moguls. You’re a good friend, but everytime you come up here with a suggestion it’s always some kind of short-sighted scheme to make money. That’s not what this thing of ours is about.”
That earned a couple of nods and a “Damn straight.” from Zafar at his left.
He continued. “If we overcriminalize poor driving, what we’re doing is sacrificing Rakin’s workforce in exchange for…nothing. We would completely freeze important institution who are suddenly bleeding key figures and employees who’ve made simple mistakes. We’re not parasites or petty tyrants. We’re leaders. We do these backdoor deals not to increase our wealth, but our resources which we must use for everyone’s benefit. We must direct the people, not root through their pockets.”
Conversation erupted, primarily economic in nature. Some offered to take care of the market in Xenagoras’s stead. Others offered grants to the arts. Others pointed to the need for construction and repairs. Some tried to give statistics on rising rates of crime and discontent within Rakin’s citizens.
One key figure of the Suite, however, was absent. She stood a few meters away, staring out the window at the city below. Her stance was relaxed, yet firm. As if she was on guard against some invisible threat. She held a small glass of scotch in one hand, occasionally sipping from it. She seemed tired. Very, very tired. This was Zhengqi Dianyou, the CEO of the Rakin Rail Corporation. Occasionally, she’d let out a yawn.
Sitting on a loveseat nearby was Ichi Ni San Go—the charge of Sing Now! who was currently too distracted to really remember she existed. Without a babysitter, she was content to simply exist next to Zhengqi, looking out the window with her at the beauty of the city and occasionally asking simple, childish questions.
They were approached by a figure, glowing in the light. Someone followed close behind.
｢Diamond Life｣, the Stand of the every-mysterious head of the Metropolis Suite. Said user hung close behind. Zhengqi always found her boss’s habit of speaking through their Stand peculiar; she understood it as a security tactic, but it often came up even in casual scenarios. “Enjoying the event, you two?” It asked. Its tone was genuine—the Stand could be a tool of intimidation whenever its user willed it so, and this wasn’t that.
Zhengqi just grunted, turning around and finishing off the scotch. She set the glass down on a nearby table, looking at ｢Diamond Life｣. “I’ve never understood how it’s so easy for you to talk through that thing—”
｢Diamond Life｣ shot forward with incredible speed, shushing the name with a single finger gently placed on her lips. “Careful, Ms. Dianyou. The end of the table. Do you see him?”
Her eyes crept towards the table, landing on a man nodding idly to the talk. Iron Butterfly was a member of the Suite who often remained in the background; to her understanding, he helped keep the Suite in control over a good deal of the crop farming in the more rural parts of Rakin. She looked back at the Stand, and it elaborated: “He’s wearing a wire. Loose lips aren’t ideal tonight.”
Zhengqi just sighed, running her hand through her hair as her other put ｢Diamond Life｣’s hand back down. “I’ll take care of him after the meeting.” She offered. ｢Diamond Life｣ chuckled, willingly pulling their hand back.
“I’d appreciate it- I had originally planned on handling the issue myself. You’re always putting your best foot forward with us—it’s something I value.”
She gave a weak smile. “It’s nothing, really. Just me giving back for everything the Suite’s done for me.”
Ichi piped up, eagerly watching the conversation. “I think Ms. Dianyou works too much…she’s always so tired and never has any time to play games or watch cartoons or do anything!”
Zhengqi did her best to put on a friendly smile. “Ichi…when you get older, sometimes you just don’t have the time for-”
｢Diamond Life｣ interrupted her. “She’s right, you know. You overwork yourself. I was being polite about it before, talking about your best foot forward- but I do worry.”
She looked at ｢Diamond Life｣ sternly. “We don’t exactly have the time to rest. I’m certain you’ve seen the news. People are starting to figure out we exist. People are hiring private detectives and holding protests. Things are starting to unravel. We need to act before things break so hard they can’t be put back together.”
｢Diamond Life｣ stood up straight, looking her in the eyes. “Trust me. I have plans, and they involve you. Both of you.”
Ichi immediately raised a little in her seat, glowing a little. “Me~? Really~?”
A friendly chuckle escaped from ｢Diamond Life｣’s nonexistent lips. “Yes, you.” A dour look plastered across its face as it looked back at Zhengqi. “I’m going to need you to handle…key targets. I want certain people out of the way and key infrastructure mapped and maintained for your “ability”—it’ll be valuable to us should the ire of the populace come to a head. Past that, rest. Allow your subordinates at Zuantou Rail to handle things. Take a long holiday. We don’t need an exhausted zombie, we need you.”
Zhengqi could only reply with silence. She knew better than to argue with ｢Diamond Life｣, but to stop working? It felt alien to her. She was tempted to clutch at her sternum from the thought.
“As for you, Ichi…” The Stand continued. “I want you to gather info for me on some of the Stand users around the city.”
Ichi innocently kicked her feet. “How am I ‘sposed to do that? I dunno any cool spy stuff, and Daddy said-”
“I’ll handle your father, don’t worry.” ｢Diamond Life｣ said, walking forward and cupping Ichi’s cheek in their clawed hand. “I just want you to make friends, okay? Go out. Explore. Meet people, as many as you can. Participate in their lives and conflicts. Tell me everything you see and hear, okay?”
Ichi just nodded, smiling widely.
“Perfect,” replied the Stand. They drew their arm back, clasping their hands together. “But enough about work. Have you two tried the finger food that’s been provided? It’s truly divine.”
Scenario: Mili's Diner, Mist City — 7:37PM
The bell above the entrance rang late into the dusk, announcing the arrival of a certain happy customer. He hummed cheerily to himself, taking a seat behind the counter and giving her regards to the woman behind the counter. His order was the same as it was every time he came here, and yet he always flipped through the menu anyway. He was a cheerful, easygoing man, despite everything.
His name was Steric Lou Farin, recently self-appointed head of PINDROP. He hadn’t been planning on it, but with the sudden departure of Sonika, the team needed someone to step up fast. He was the most experienced in the field of investigation and had the sort of charisma the role required. He didn’t mind taking the lead, either. If anything, it made his work a little easier.
Speaking of work, that was the reason for this visit—good as the food was. He glanced over to the other two customers, talking quietly amongst themselves, and smiled. Both were of particular interest.
The first was one Brighid Rhodes. He’d sparred with her a few months back, and an exchange of business cards had proved extremely wise when he needed assistance in dealing with one Texas Aco. She was the one to finally calm her down in the end—albeit forcefully, but all’s well that ends well.
Speaking of which, Texas Aco sat at the counter now, talking in hushed mumbles to Brighid. The notable thing there being that she was talking now. She had been silent in the immediate aftermath of her rampage, but after spending some time at Brighid’s, Steric had gotten the call today that she’d been ready to speak.
“I hope you all had a safe drive here,” he chuckled to himself. “It’s awfully rainy out, isn’t it?”
“Nothing too bad.” Brighid exhaled, and Texas nodded with her, sipping on a chocolate milkshake. Her misshapen insect arm was hidden under a worn old coat draped over her shoulder. Brighid gave the detective a particular glance, and Steric took that as a sign to get to questioning.
“So, Texas…” He cleared his throat, making sure he had the girl’s attention. “I’m sorry for calling you out so soon. You ever want to stop talking about all this, let me know. I don’t want to do you any harm.”
“Mmm.” Texas nodded again.
“Now, I understand you’ve had, er, a difficult last few months.” That was no understatement: she’d been directly responsible for an attempted VULTURE mutiny. It failed, and drove her off into hiding god-knows-where. “In particular, I’d like to ask you about your relationship to VULTURE. It’s a piece of the puzzle here I haven’t entirely been able to ascertai-”
“I’m taking over VULTURE.” Texas deadpanned. Brighid sighed.
“I told you that isn’t the best idea.” The lawyer attempted to flick her on the forehead. “That’s too dangerous. No way you can get it done on your own.”
“No, I mean, like-” Texas grumbled. “She literally told me I could have it. The old boss.”
Brighid blinked a few times. She hadn’t heard about that. Steric nodded.
“Ms. Kaliya told me she’d been in contact with you. She said you’d been pretty against taking the leadership role, though.” Steric raised an eyebrow. “What changed?”
“…It sucks here, man.” Texas smirked. “Even with all the bullshit charities, shit’s gone bad after Rasna left. I’m sure you caught wind of that. Guys turning up dead left and right—there was a fight at a funeral, right? Whole place got blown to smithereens. What the fuck, man.”
“Ahah, yes.” Steric winced. “Quite the festivity, wasn’t it.”
“The place needs someone to step up. And with that little rampage I went on…” She looks embarrassed, for a moment. “I think I’ve got the rep to fill her shoes. Er. Maybe. I’m not really that scary, but, uh…”
“Ms. Kaliya told me you weren’t of that sort of opinion before.” Steric raised his eyebrow again, tapping his pen against his notepad. “What changed?”
“…Nothing, really. I just.” Texas chuckled, reclining on her stool. “I don’t really think anything I’ll do will have any difference. But I can’t stop myself from trying, either. I don’t think she’d want me to, either.”
Brighid placed a hand on the girl’s shoulder, glancing down at her. “Long as you come back to my place when you’re done. I trust you, but you should have a bed to sleep on.”
“Yeah, yeah.”
Steric grinned. This was a good development! A bit risky, sure, but it gave him in an in. “Say!” He stopped absentmindedly chewing on his pen’s tip. “Y’think you’d be willing to help us out? VULTURE’s assistance would be a great help…and something tells me we’ve got a common goal.”
“I’ll think on it.” Was Texas’s only response. Brighid flicked her on the forehead again. “Ow! Okay, fine, yeah, I’ll help. You guys don’t seem that bad.”
Steric clasped his hands together. One step closer. “Ah, and you too, Miss Rhodes.”
“Hah?” Brighid scoffed. “I don’t think anyone with me is gonna be much help-”
“I think that’s, er, preposterous.” He tapped his notepad a few times. “I did some looking into the work your people’ve done recently. For museum staff, you folks sure are prolific. A boat raid is quite the accomplishment. Hmm, hmm~.”
“Well, er…” Brighid sighed. Her group had had a history of engaging in combat. Entities like Paranoia and Markov were practically built for it, but her group had had similar exploits recently: Ruby’s left her fight with the swordsman at the art college relatively unharmed, and Roxanne had managed to charm an ex-member of Metropolis. Despite how weird all of them were, they were useful in a variety of ways; it made sense Steric wanted their assistance.
“Alright. I’ll get them to help out.” Much as she didn’t trust some of them with heroism, Brighid found herself more involved than she’d anticipated—and getting into the action herself meant she could help keep Texas as safe as possible, despite everything. “But you gotta help out with the museum. We’re, uh, still working on reconstruction.”
“No worries. I think I’ve got a few artifacts here and there. They’d be fit for your collection.” Steric’s phone buzzed—he rose and nodded at the two. “It’s been a pleasure, folks, but the life of a detective is ever so busy. Be seeing you.” With that, he grabbed his coat and strode away, leaving a good third of his burger.
Several oversized flies crawled out from beneath Texas’s coat, nibbling on the leftovers. “You really okay with me, uh, y’know…” Texas made a few vague gestures with her hands. “It’s a big thing to, uh, undertake. I figured you’d try to stop me.”
“I doubt I’d be able to.” Brighid chuckled. “‘Sides, you’re a pretty tough kid. I was pretty rough and tumble when I was your age, and look how I turned out. I’m a lawyer and everything.”
Texas nodded, returning to her milkshake. She was an ant under an elephant’s foot—she’d become well aware of that. But even so; even an ant had its resolve, and a swarm could pick apart a carcass. Even if it was only delusion, she’d do what she could. Mom would’ve liked that.
“Mmm.” She grinned. “Here goes.”

<=TO BE CONTINUED==

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Hey everyone. Looking for advice besides “lose weight” or “stop eating steak”. Looking for real tips from other people who suffer from this. Thanks
I’ve had gout attacks for probably the last 5 years or so. The biggest struggle is avoiding high purine foods. It seems there is so many foods that are high or have moderate purines that are good foods for a diet. I went the avoid route for a while. Now when I exercise a few days in a row it I’ll start to get foot pain by day 4 and then boom, flare up. I’ll be doing fine, go on vacation, enjoy some of the good foods maybe a few drinks, boom flare up. Gout seriously holds you hostage and pops up at anything lol.
Who has been successful with creating a weight loss diet and avoiding the high purines? What do you eat?

Hi gout community! With Gout Awareness Day approaching next week, I wanted to take a moment to share some important information about living with gout and managing it effectively. Living with gout can be challenging, especially when there’s so much conflicting information out there. Today, I want to debunk a few common myths to help you navigate your gout journey with accurate knowledge.
First, many people living with gout believe that gout is self-inflicted due to overindulgence in rich foods like shrimp and steak. While these foods can trigger gout flares, they are not the root cause of the disease. Gout develops because the body struggles to efficiently filter uric acid. So, don’t blame yourself – gout is not just a result of lifestyle choices.
Also, another common myth is that dietary and lifestyle changes alone can manage gout. This isn’t entirely accurate. Most people with gout need daily uric acid-lowering medications to bring their uric acid level down to the target of 6.0 mg/dL. These medications are crucial for minimizing the impact of the disease. So, while it is important to maintain a healthy diet and reduce the frequency and severity of flares, it cannot cure or entirely control gout.
You can read more about common gout misconceptions on the Gout Education Society’s website.
Be on the lookout for more tips to manage your gout from me in the coming months. I’ll also be back for an AMA on May 21^st - stay tuned.

I will try to keep this short. I have a kind of love/hate relationship with my ex. Our relationship ended decades ago, and for a while we didn't really talk, but after a few years were able to be friends. Until a few months ago, we saw each other every day, and would help each other out, as we kind of needed each other. We both moved abroad when we were young (separately, we met here) and have no family in our current country.
While I kind of "needed" him, and he me, he would drive me nuts. He couldn't open his mouth without annoying me. Our personalities are very different, hence why our relationship ended after 6 years. We would be driving along, and he would be going on about whatever, and I would just say hmmm at intervals, while in my head I would be screaming at him, "Just shut up! WTF can't you just shut up! Stop talking rubbish!" etc, but always along the lines of stop talking, and just shut up. I often actually said it, but it made no difference. While I was screaming at him in my head, I had an intense feeling of irritation, so strong, it was also a physical feeling, filling up my entire chest/stomach area.
Anyway, long story short, at the end of Feb he got a fever, and cold/flu symptoms. He was in bed, and I was going to his place to do his chores, make him food etc, which sounds nice of me, but I resented having to go. The cold then developed into what he thought was gout, then his shoulders became very painful. After a week of him getting into bed with the cold/flu, I called an ambulance. He was taken to hospital and ended up in Intensive Care on life support for 20 days. His body had gone into sceptic shock. They do not know what caused it. He was in an induced coma and almost died several times. After about 5 weeks, he was moved out of Intensive, to a floor for critical/semi critical patients. He was awake more now, but could not talk because of a tracheostomy tube. They wanted to take it out about 10 days ago, but found he had a throat infection, which had given him nodules, and had to wait for them to go. So the last week, he was communicating by nodding, shaking his head, and writing on a pad.
Two days ago, he had the tube removed, and could finally talk again. Needless to say, not for the first time during these last few months, I was crying with happiness just to hear his voice. I won't go into how hard the last few months have been for me trying to cope with my own stuff, his, every other day hospital visits (45 miles away), and taking care of both of our animals etc.
A few days ago, it struck me that I had manifested this situation. I had wished very strongly that he would just shut up, and it happened. Of course, the way it happened is not what I wanted, I just wanted him to talk less about people, or only when he had something of interest to say. I have learned a very hard lesson, but I had held the intention for him to shut up with strong emotions, almost every day, over a period of time.
I am now trying to work out steps to reverse engineer this into something I do want. I guess I did the shouting in my head for at least 10 minutes, almost every day, for several months. Of course, I could shout in my head for what I do want, but I don't know how to word it, or how to bring about the intense emotions and feelings I had when it was something I found extremely irritable/negative.
Any ideas?
The good news is, he is improving every day, and hopefully should be out in a week or two. I will not be doing that again. Just very grateful he got through it.

Context: I have been on allopurinol for a couple months and have reduced both purine rich and trigger foods from my diet. A couple weeks ago, I ate some marinated crab with roe, which hadn't been an issue, especially in moderation, but this ended up triggering the worst gout flare I've ever had in my life. My foot was practically double the size of the other. I was able to secure some colchicine for more rapid relief.
Fast forward to two weeks after the gout flare, my ankle, which is where the attack was centered on is exhibiting a couple of weird things and I wanted to get a bit more information on whether it's lingering symptoms of gout, or something worse.
Symptoms:

• During the flare, it seemed like my ankle was bruised. While mostly gone, the ankle still looks slightly darker
• When I am sitting down in a chair and I try to raise and/or extend my leg out, a stinging pain shoots up from the ankle near the joint
  • This is the main concern. It seems like I've lost a significant amount of mobility
• If i were to stretch my legs standing up, feet facing forward with my left knee bent and right leg extended, the area under my ankle joint exhibits the same pain
• When I run, using the balls of my feet, the downward impact hurts the same ankle area

My concern: It's been more than two weeks since the flare occurred. While I understand lingering pain can persist, this pain does not seem to be going away nor getting milder. It's also weird to me that the pain is so sharp and only for specific movements/positions.
Does this seem normal? I obviously don't want to suspect joint damage, tissue damage, or something worse. I realize I should probably go see a doctor before my insurance runs out, but wanted to see if anyone else has experienced something like this, and whether I would be able to wait it out.
Happy to provide additional information if requested

My dad has dealt with gout for many years now. He is an overweight, semi-retired, 56 year old high shool soccer coach. He is very active for his age, but definetly more limited than he would like these days. He can no longer do lunges, one of his favorite excercises, because he cannot bend the joint that connects his metatarsal to his proximal phalanx in his big toe. He explains that this pain and stiffness started because of a severe gout attack 5 years ago.
His gout seems to be brought on by dehydration, not purine rich foods, if that helps at all.
I want him to get back to all the activities he loves, at least at some level. Does anyone have any expereince with this or any advice?

Hi everyone,
I am a 41M who is Caucasian, 6'3, 231 pounds as of this morning.
Over the past couple of months, I have been working hard to improve my health, on the advice of my doctor. All of this started when I mentioned to him that I had been experiencing some mild ED symptoms since entering my early 40s. Instead of immediately prescribing me ED pills, my doctor warned me that those symptoms can sometimes be a first warning sign of something more sinister, like cardiovascular issues. He ordered some blood work and encouraged me to read Peter Attia's book "Outlive" which I bought the next day and read over the span of two weeks.
Following that appointment, I also immediately started exercising (aiming for Zone 2 based on the book), changed my diet to eat cleaner, practiced time-restricted eating (18 hours of fasting on all but two days for the past month), and have only had alcohol on a single occasion (though I was always a very infrequent drinker and don't smoke).
My biggest issue is likely my weight, which was 244 pounds when I made the initial doctor's appointment. Since making lifestyle changes, I am now down to 231 pounds as of this morning... and I'm not stopping here. I am aiming to get down to the 200-210 range.
Recently, I had some follow-up blood work done, and it did show that my LDL and HDL levels were abnormal. I was hoping that some of you might be able to look at the results (below) and let me know whether these results are quite concerning, or whether they are relatively close to the normal range and could be corrected if I stay the course with my lifestyle changes.
For what it's worth, my doctor told me to book a follow-up appointment in about a month and said that we would do further blood work and testing then. He did mention in his notes that he thinks it could be some kind of disorder of lipid metabolism, which has me concerned.
He also asked me about my low MCV and MCH levels last month and this month, including whether I knew if I was anemic (news to me!) and if I had a family history of complex dyslipidemia (which, to my knowledge, I do not).
The only existing medical condition I have is gout, which I treat using allopurinol (one 300mg tablet a day). I haven't had a gout attack in over a year, thanks to the medication, and my urate is generally in normal range now.
In June 2023, I also had an issue where I had to unexpectedly have my gallbladder removed, due to small gallstones that had escaped and got into my pancreas, irritating it and causing pancreatitis. As far as I know, I have recovered fully from that surgery and my blood work / liver enzymes all returned to normal levels.
The only lasting side effect after having my gall bladder out is that I now get diarrhea from certain foods and yellowish loose stools, which I think is from "dumping." I notice this happens most often on days when I have coffee from my French Press, and I wonder if somehow I am now sensitive to the coffee grounds.
Sorry if this is information overload, but I want to provide as much detail as possible. I will also attach some images of my latest blood work results. Thank you in advance for any insights you can provide about how concerning these results are and what issues I should consider looking into. I would also be open to any other over-arching advice on how to improve my health and my life - including other book or podcast suggestions.
I appreciate this subreddit very much!

Hematology results for May: https://imgur.com/AaCSbfA
Lipid results for May: https://imgur.com/vJH5Yy8

So I am almost 44 was diagnosed with gout about 12 years ago. Been on allopurinol since that initial diagnosis and have often gone 12-18 months between flare ups sometimes longer once even almost 3 years in between. I have always eaten a decent diet but I recently started trying to lose weight and live an even ealthier lifestyle. **Alcohol 1-2 if not 3 days a week was being consumed now down to couple times a month. Playing pickleball, more hiking/biking and less drinking since January 1st as a New Year’s resolution. I also started Keto with the wife and have been doing Keto and intermittent fasting since then (was fully keto through March now eating Keto about 90% of meals/snacks). I have lost 27lbs and am pretty much at my goal weight. Currently weigh 188 (goal was 185) at 6ft tall. Keto makes me feel fantastic in terms of energy, weight loss has been a huge success. I also supplement with Vitamins, B12, D, calcium, magnesium, daily multivitamin and tart cherry extract almost every single day.
My elbow started bothering me off and on when I switched to keto but was also playing pickleball and doing push ups so generally when I laid off the pickleball/push ups for 3-4 days it got better. Didn’t even think it was gout related at first. I am now going on two weeks with a really bad elbow flare. Took about 6 colchicine after the first 3-4 days when I figured out it was in fact gout and not tennis elbow, and now it just won’t quit. I know you don’t want to keep takin colchicine so I stopped taking it 4 days ago. Usually that knocks it out. Stopped all lifting, exercise using the elbow, pickleball, etc. Feels 75% during the day and on fire at night. Drinking 100 oz of water at a minimum daily.
Everything I read about keto was the diet change would cause flare ups initially in the first few months due to the change in diet but if not smashing red meat and purine rich foods it should regulate back to normal.
Any ideas on things to try to get this knocked out?
Anyone else doing keto and seeing increased flare ups over a prolonged period?
Anyone doing keto long term and seeing it go back to “normal” in terms of flare ups?
Any other suggestions on ways to calm this flare up down?
Anyone else have flare ups in the elbow and have recommendations?
Any help would be appreciated, sorry for the long post kept thinking of more info to add haha.

Hey everyone,
I was recently diagnosed with gout and am trying to manage it through diet. I'm finding it quite challenging to identify foods that are high in fiber but low in purines.
I used to enjoy eating oats (porridge or with yogurt) and broccoli/spinach as vegetable sides.
For those who are more experienced with managing gout, what fiber-rich foods do you include in your diet? Are cooked foods (like porridge and broccoli) less problematic than fresh ones?
Thanks for your help!

I've been lurking in the community for the past few weeks. I'm on day 23, 49 years old, and following a clean keto diet (don’t fret about the Keto label, it’s just more descriptive than 'whole foods with minimal carbs').
I started a Couch to 5k program in the second week, and aggravated my knee (I had ACL surgery 20 years ago). While my knee has been 'tight,' I've continued to walk but stopped doing squats and pretty much avoided leg days. Unsure of how far to push it, I scheduled a visit to my ortho doc, whom I met with today.
He thinks it could be arthritis from the old injury or it could be gout (I have a history, and tested super high for uric acid a week ago; I started allopurinol and colchicine 5 days ago as a result) or both. Either way, he wants me off it until it settles down, and that only includes minimal walking.
It's a bummer because I'm really starting to enjoy my walks. Not only do I see myself getting faster and feeling stronger, but they're super convenient. I can walk my dogs, do it from home, go with my wife/kids, etc. I'm too stubborn to quit the challenge, so now I'm forced to understand the 'mental' side of it. It’s not just about getting in better shape; it's about rising above adversity and pushing through the challenge, even when conveniences break down.
Anyone know how I can get cardio in without using my legs?
Until I figure it out, my chest/back and arms are going to be huge.

Last year I got way into Ayn Rand. Started with Fountainhead (because of bio shock and cumtown lol), loved it. Read a few more of her books like the New Left, and Virtue of selfishness AND then Atlas shrugged. Atlas Shrugged lost me. I stopped at around 900 pages. The writing and story just wasn't compelling but I still liked a few of the concepts.
Anyways, Im curious what others think of her stance in technology and industrialization with todays perspective. From what I gather, she hates the hysterical hivemind. How nothing seems to get done when everyone's playing a game of telephone, differing every problem to the next grunt who's just as clueless to a solution as the last. She loathes altruism/virtue and sees it as a manipulation tactic to create weak spineless pander goblins who only feel redemption from the approval of others (or god). And while these don't directly correlate to technology, I feel that modern technology awards hysteria, groupthink and performative virtue. (Kind of social medias only function these days, if you ask me)
I remember a part at the beginning of Atlas Shrugged where she writes about how if peoples microwaves were taken away (in hopes to save the environment) they would probably start a riot. Everyone can preach their good intentions but the second convenience is threatened it becomes a personal attack on life itself.
From what I gather, she has a catch all attitude about technology. Yes, some of it will be bad but the progression of humanity should be pursued at nearly any cost. MAN VS THE WORLD. However technological advancement today seems less about discovering or dominating the world and more about creating a new one, via the internet, VR or even iPads in cars. I guess thats all very new and ultimately Lindy will see what sticks, but if this is the progression- it will be MAN VS THE WORLD MAN CREATED.
I have trouble seeing what todays technological advancement is leading to, other than infantilized obese Disney adults who have no self discipline. They're probably gonna have to rebrand the WHEEL CHAIR as some new luxury time saving go cart because of the gout and oil flowing through the average Americans clogged arteries. If money talks, it seems like (from observation) most of what the average person spends their money on is: digital entertainment, horrible oil infused foods and weed/booze.
Bit of a ramble but im interested if you have thought about her writings of technological and scientific advancement in todays terms where you can literally make money by being an "Influencer". Do you think she would still stand her views of technology?

You’ve all likely taken a pain medication at some point, so I thought I might offer a little more info about some of the different types.
Acetaminophen (Tylenol) is great for pain and fever, but it is not an anti-inflammatory medicine. Acetaminophen is known to cause liver damage when taken in large quantities, and this medication is included in many different OTC formulations such as cough and cold medicines. Patients should always check ingredients to ensure they are not double dosing unintentionally, and limit use when possible.
The term Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) encompasses a wide range of medications that help with pain, fever, gout, blood clots, and inflammation. Because these medications work differently from acetaminophen, it is generally safe to use both if your primary issue is pain and/or fever; however, you should never use two types of NSAIDs together due to their adverse drug effect (ADE) risks.
All NSAIDs are known to cause kidney damage, but liver damage is possible in high doses. In addition, some NSAIDs can increase the risk of bleeding, cause heartburn and stomach ulcers, increase blood pressure, cause heart problems or stroke, and may cause allergic reactions. Frequent/long term use is not recommended without oversight by a physician. NSAIDs are best taken with food and possibly a H2RA/PPI (see previous reflux post for more info on these meds) to help prevent GI bleeding.
Some common NSAIDs include: Aspirin (Bufferin, Ecotrin-low dose used often for blood clot prevention) Ibuprofen (Advil, Motrin) Naproxen (Aleve, Naprosyn-12h dosing) Diclofenac (Voltaren-topical options available; higher risk for liver and heart ADEs) Indomethacin (Indocin) Meloxicam (Mobic-24h dosing) Ketorolac (Toradol-high risk for ADEs; use should be limited to 40mg max daily and 5 days use) Celecoxib (Celebrex-less risk of GI ulcers but increases risk of heart problems)
Also note that children with viral infections should NOT take aspirin due to the risk of Reye’s Syndrome
Corticosteroids (different from anabolic steroids) are synthetic versions of cortisol that are also used for inflammation by affecting the body’s immune response. They are commonly used for allergies, asthma, arthritis, and autoimmune diseases, yet they can have a wider variety of ADEs especially when used systemically, such as weight gain/water retention, mood changes, increased body hair growth, increased risk of infection/difficulty fighting infections, easy bruising, GI bleed risk, increased blood pressure and sugar, etc. Some examples are cortisone, hydrocortisone, methylprednisolone, prednisolone, prednisone, triamcinolone, betamethasone, dexamethasone, and fludricortisone. (NSAIDs and steroids should not be taken together.)
Lidocaine and/or menthol is also a great option for pain that is available in many different dosage forms. Some antidepressants like selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), or tricyclic antidepressants (TCAs) and some anticonvulsants can be used for certain chronic pain conditions. Muscle relaxers are useful for muscle tension and spasms.
When necessary opioid pain medications may be prescribed. These should only be used as directed because they carry high risks for ADEs, such as respiratory depression and dependence. Opioids cause intestinal movement to slow resulting in constipation so it’s important to also take senna, which directly stimulates the intestines to move, otherwise you get “all mush, no push” if you only use other constipation meds! 🤪
P.S. Physical therapy and dry needling can also be a great way to relieve pain!! I get needling regularly for my myofascial pain syndrome so I can attest that it helps tremendously!🤩
This website has some great additional info if you want to check it out!

So for the past 4 days my gout as flared up and can't even put any weight on my foot. I assume the high purine In ground beef isn't helping. What other foods can I consume. I am eating oranges and pineapple as this is good for it, apparently. I will up my egg intake to about 8 a day, but I need other foods for protein.

I posted this in another subreddit and was advised to post it here, so apologies if you’re seeing this twice.
I have a few health issues, mainly PCOS and a genetic predisposition to things like gout and diabetes, and I am looking to find the right diet and lifestyle that works for me. I am vegan and have been for about 2 years and have seen wonders done when it comes to PCOS as well as weight management since I am very overweight. However, it alone has not made me 100% comfortable with where I am now. In addition to added exercise and making sure I’m consuming whole foods, I was wondering about gluten. I’ve seen some people mention that consuming less gluten or no gluten helps with their PCOS and weight loss, but I’m not sure the extent of it. And was wondering if anyone in here is gluten free. I would love to hear your comments on if being gluten free helps you or if you have info in it!