#colchicine poisoning

[pdfbabe]

started watching house 👍it's pretty fun

[cupcraft]

Ctommy and ctubbo break into Princeton Plainsboro hospital actually and decorate the walls with the pharmacy pills and only doctor hpuse can reorganize all the pills before cuddy comes at 8 am that morning bc he knows what every pill is by looking a la that one episode with colchicine poisoning due to pharmacy error. But he keeps a mural of drugs in Wilson's office that says marry me ? So all his patients congratulate him and no one thinks he's available to date now and house wins really. And cclingy also are shadowing house now yeah and they play Mario kart together on the GameCube in the autopsy room.

[specsthespectraldragon]

#and hearing the tone of the buzzing ABRUPTLY change when they smell me Specs, do you unintentionally put off 'fucking fight me' pheromones?

I think it's the colchicine, but I'm not 100% on that because I've always had bad luck with wasps even before that. I know the colchicine DOES impact something about my scent, because mosquitoes and biting flies know I'm poisonous and avoid me (ticks do not, bite me, throw up, and die, which is how I've had Lyme 5 times and counting).

But, yeah, it creeps beekeepers and insectarium staff out that I can do that.

[zenyteehee]

(Imma start off by saying that I appreciate all of the people in my life and I know I have so much support, that some of the people I know I can go to for support will probably read this and I appreciate you so much but I feel bad always coming and dumping on people so for today Imma just shout into the void).

Lupus doesn’t get to win the war, but it did win these battles. It involved my heart. I believed the worst was behind me. I was working through my imposter syndrome at being well-controlled/in remission. I had started working out again. I was working on my me tak health, which I had been hiding from. I took risks and lived my life. I was making plans to train for a triathlon, what I had been doing when I got sick in the first place. Then the lupus involved my heart. In hindsight, it probably has involved my heart from the very beginning, but I have definitive proof now. Pericarditis minimum. Maybe myocardial involvement, we’ll have to see what the echo shows. I’ve had this proof for a solid month. Meds have been making it better. But I feel no better about it, because the meds are a literal poison and if I don’t waterlog myself during the day, I spend the night feeling like I’m being poisoned, not that I do anything with what little time I have to myself anyway because the bout of depression the lupus brought with it has dragged me away from all my hobbies as well.

I feel bad. I have no stress tolerance. I haven’t been treating the people in my life well. I’ve been shutting people out. When I do talk to people outside of school/work, I end up dumping on them even when I tell myself I won’t talk about lupus this time. But what else am I supposed to talk about when my life consists of going to work, studying, and then lying on my bathroom floor because colchicine makes me so sick but at least I can lay down now. Otherwise my hobby is getting baked so all the bad feelings go away. Which isn’t so fun to admit. And I hate the people around me that talk about working out and goals and “they’re not pill people”.

People tell me they’re hopeful for me and I know they mean well and I should be hopeful, I want to be hopeful, but I’m not. I’m fucking devastated and I don’t think I’ve let myself fully realize how devastated I am. I wanted to be a surgeon. Idk if that was the right path for me or not but I was considering it. I wanted the choice. I don’t have that now. Lupus made it for me. I’m too sick to be a surgeon. That’s the truth. I’ve been saying “I like hobbies more” blah blah but I wanted to be a general surgeon. Nothing has ever made me feel as alive as that. Lupus stole so much this time. I had hope and lupus stole it. I try to have hope, adapt and conquer, I can find happiness right where I am, I can build it, but I still hear how short of breath I get. I see how my animals look at me, like they’re scared, freaked out, because they know what my heart should sound like and it doesn’t sound like that now.

I’m still in medical school. I’m still a full time student and a full time worker. I will go to residency in something and I will build myself a life but this will never not sting. I don’t know if I would have picked surgery or not, but above all I wanted the choice. And lupus stole it. And I hate being the sick one, the chronically ill one, the lupus patient. I hate how so much of me has become that. But how can it not.

[sidewalkchemistry]

Tomatoes (Solanum lycopersicum, Solanaceae - Nightshade Family)

Native to Mesoamerica though via colonization tomatoes became a signature ingredient in European cuisines (eg. Italian). Modern cuisines worldwide, in fact, would look much different if Indigenous Americans were unaware of the brilliance of the tomato.

Interestingly, the fruits were previously shunned and thought to be deadly poisonous by Europeans and American settlers. This scenario has lent itself to the term 'tomato effect.'

Coined in the Journal of the American Medical Association 27 years ago, the tomato effect describes the rejection of highly efficacious therapies by the medical establishment because they happen to go against the prevailing conventional wisdom.

Imported from the New World, “By [the year] 1560, the tomato was becoming a staple of the continental European diet…[A]t the same time it was actively shunned in North America [for literally centuries]… The reason…is simple: they were poisonous. Everyone knew they were poisonous, at least everyone in North America. It was obvious.”

Examples of this tomato effect—a slavish devotion to orthodoxy—are mentioned in medicine. For example, ignoring the successful use of this plant in the treatment of gout for a thousand years before modern medicine “discovered” it was the drug colchicine. Aspirin was also ignored for almost 3,000 years of successful use as willow tree bark extract.

Tomatoes used to grow as wild as weeds in Central and South America. The Aztecs and Incas were among the first known to use the plant in their food.

They have an unmistakeable bright cheery taste which fits into the savory & umami flavor categories. They are also very cooling and hydrating in nature, which allows it to harmonize perfectly with the sunny days of its growing season. A simple taste of tomatoes captures the essence of such days. It's no wonder why it is one of the most consumed "vegetables" in the United States, even critical to many fast food dishes.

The leaves of the tomato have also been feared, even into our current times. But many have eaten & cooked with it, though it would be unwise to consume the leaves in excessive portions, which is the same for any one leafy green. Due to the content of antinutrients in leafy greens combined with the varied ability to handle these antinutrients (eg. oxalates), which is thought to change according with one's genetics & gut microbiome status, eating an assortment of different greens is a general nutritional recommendation.

The tomato fruit is a notable source of Vitamins C, E, and K, potassium, and lycopene (an antioxidant, and thus gives tomato the reputation of aiding prevention against inflammation-related diseases and imbalances). On a similar vein, it is brewed as tea, though very rarely, to bring relief to cold & flu symptoms.

Nutrient absorption of the tomato is thought to be improved once cooked or processed in other ways which softens the cell walls. The combination of tomatoes and olive oil may also been an intuitive realization of increased nutrient absorption.

The fruit is a main ingredient in the following: sauces like marinara, ketchup, salsa, pico de gallo, tomato paste, tomato juice, tomato soup, gazpacho, pizza, ratatouille, paella, tagine, bravas sauce, shakshuka, fried green tomatoes, jollof rice, tomato galettes, butter chicken, tikka masala, saneyet batates, burgers, etc.

Its flowers tend to be small and yellow. The flower's energies have been captured in vibrational flower essences. They're thought to hold a 'warrior energy,' with qualities of mental strength and endurance. It has been reported to aid with nightmares, depression due to unhappiness with one's weight, dentist's office anxiety, pets with uncontrollable fear or a history of traumatic abuse, and addiction management.

(Photograph by Mats Dreyer)

[monmorgandy]

Colchicum autumnale by Giuliano Da Zanche Via Flickr: Colchicum autumnale (Colchicaceae) 257 22 Colchicum autumnale, commonly known as autumn crocus, meadow saffron, or naked ladies, is a toxic autumn-blooming flowering plant that resembles the true crocuses, but is a member of the plant family Colchicaceae, unlike the true crocuses, which belong to the family Iridaceae. The name "naked ladies" is because the flowers emerge from the ground long before the leaves appear. Despite the vernacular name of "meadow saffron", this plant is not the source of saffron, which is obtained from the saffron crocus, Crocus sativus – and that plant, too, is sometimes called "autumn crocus". This herbaceous perennial has leaves up to 25 cm long. The flowers are solitary, 4–7 cm across, with six tepals and six stamens with orange anthers and three white styles. It is occurs across mainland Europe from Portugal to Ukraine, and is reportedly naturalized in Sweden, European Russia, and New Zealand. Colchicum plants are deadly poisonous due to their colchicine content. The symptoms of colchicine poisoning are similar to those of arsenic, and no antidote is known.

[theinkbunny]

”Colchicine poisoning has been compared to arsenic poisoning; symptoms typically start two to five hours after a toxic dose has been ingested but may take up to 24 hours to appear, and include burning in the mouth and throat, fever, vomiting, diarrhea, abdominal pain, and kidney failure. Onset of multiple-system organ failure may occur within 24 to 72 hours. This includes hypovolemic shock due to extreme vascular damage and fluid loss through the GI tract, which may result in death. Additionally, those affected may experience kidney damage resulting in low urine output and bloody urine, low white blood cell counts (persisting for several days), anemia, muscular weakness, and respiratory failure. Recovery may begin within 6 to 8 days. There is no specific antidote for colchicine poisoning”

which is this flower

“all parts of these plants are poisonous, especially the seeds and flowers. Ingestion may cause abnormal thirst, hyperthermia, severe delirium and incoherence, visual distortions, bizarre and possibly violent behavior, memory loss, coma, and death. ” + “the difference between a recreational dose and a lethal dose is minuscule, and incorrect dosage often results in death. ”

Not to mention this plant is often known for suicides and murder.

and last but not least

”Within a few hours of the ingestion of a toxic amount of plant material, a victim may experience nausea, vomiting, numbness and tingling around the mouth, burning in the throat, abdominal pain, and bloody diarrhea. As the toxic syndrome progresses, rhabdomyolysis, ileus, respiratory depression, hypotension, coagulopathy, haematuria, altered mental status, seizures, coma, and ascending polyneuropathy may occur”

This flower

”I’m literally such a bad ass” <- has been studying plants for three hours at this point

[itsdoctorhouse]

Occam’s Razor

CC: Patient presents with cough, rash, dyspnea, syncope, and abdominal pain.

Dx: Colchicine poisoning

Syncope

Temporary loss of consciousness caused by a fall in blood pressure.

aka fainting, passing out

Hypothyroidism

Reduction in the production of the two hormones produced by the thyroid, T3 (triiodothyronine) and T4 (thyroxine). 

The two hormones regulate the body’s temperature, metabolism, and heart rate. 

T3 is the active hormone, T4 is the precursor, both circulate through the bloodstream.

T3 functions include the 6 B’s:

Brain maturation

Bone growth

Beta-adrenergic effects

Basal metabolic rate

Blood sugar (glycogenolysis, gluconeogenesis)

Break down lipids (lipolysis)

Most commonly affects women above the age of 50.

Symptoms include:

Goiter: enlargement of the thyroid gland, it’s the characteristic neck mass shown in most tv shows, not to be confused with enlargement of salivary glands which show growth more along the jawline.

Metabolic: Cold intolerance, hypohidrosis (reduction in sweat production), weight gain, hyponatremia (reduced sodium in the bloodstream)

Skin/hair: Dry, cool skin (due to reduced blood flow), coarse, brittle hair, diffuse alopecia, brittle nails, puffy facies and generalized nonpitting edema (aka myxedema)

Ocular: Periorbital edema

Gastrointestinal: Constipation, reduced appetite

Musculoskeletal: Hypothyroid myopathy (proximal weakness), carpal tunnel syndrome

Reproductive: Abnormal uterine bleeding, reduced libido, infertility

Neuropsychiatric: Hypoactivity, lethargy, fatigue, weakness, central nervous system (CNS) depression, reduced reflexes

Cardiovascular: Bradycardia, dyspnea on exertion

Common underlying causes:

Iodine deficiency - because the hormones are basically composed of iodine with some extra spice.

Malfunctioning pituitary gland - because the pituitary gland signals the thyroid to produce hormones (through TSH-Thyroid stimulating hormone), classified as Secondary Hypothyroidism because the problem does not directly derive from the thyroid.

Trauma to the thyroid gland.

There are a lot of other etiologies/causes that I can’t go over one by one just by necessity because the list would add another 10 pages. But my favorite is definitely cretinism (congenital hypothyroidism) just because it was actually mentioned in Paternity (s01e02) as part of a crossword puzzle.

Colchicine poisoning

Pharmacy error in this case, a switch-up with the cough medicine.

Used to treat gout: a form of inflammatory arthritis, characterized by recurrent attacks of red, tender, hot and swollen joints. Due to persistently elevated levels of uric acid in the blood which form crystals within joints and kidneys.

Overdose begins with a gastrointestinal phase 10-24 hours after ingestion, followed by multiple organ dysfunction 24 hours to 7 days after ingestion.

Symptoms include: 

Burning in the mouth and throat, fever, vomiting, and abdominal pain.

Hypovolemic shock due to extreme blood/fluid loss through the gastrointestinal tract.

Kidney failure follows 

Alopecia: loss of hair, aka baldness

Bone marrow depression: decrease in production of cells responsible for providing immunity, carrying oxygen, and/or those responsible for normal blood clotting. 

Agranulocytosis: lowered white blood cell count

Aplastic anemia: failure of production of blood cells

[forensicfield]

Lethal Dose of Poisons

Lethal Dose of Poisons

(more…)

[flowerishness]

Colchicum (naked ladies, autumn crocus) and Agapostemon (metallic green sweat bee)

Today’s ‘Spot the Bee’ contest features a metallic green bee and the lovely autumn crocus in our back garden. However, this post is actually about the flower and a very powerful poison made from the autumn crocus called colchicine. Colchicine has legitimate medical uses and is still used to treat gout but it was at the center of a notorious murder case in Victorian England.

Catherine Wilson worked as a live-in nurse and she murdered seven of her patients using colchicine. She first convinced her elderly patients to sign over all their worldly possessions to her by modifying their wills. Colchicine poisoning is a nasty way to die (think: writhing in agony) and she stood at the end of the bed in each case, to enjoy the show, She also poisoned her husband and at least three other ex-lovers. During her last (unsuccessful) attempted murder, she prepared a “soothing draught” and encouraged the elderly lady with the words, "Drink it down, love, it will warm you up."

After finding her guilty, the presiding judge described her as “the greatest criminal that ever lived.” She was executed at Newgate Gaol on October 20. 1862. Indeed, the case became such a sensation that a crowd of 20.000 showed up to witness her execution. Catherine Wilson was the last woman to be hung in London.

[specsthespectraldragon]

Yeah, my colchicine is ludicrously expensive because it's not profitable to test it on people without gout. ...So I bought some autumn crocus seeds online and they're chilling in my fridge right now.

Says a lot about the bullshit status of the healthcare industry in this country that the safe, relatively inexpensive medication that works extremely well for me to keep my intestines from declaring mutiny is subject to frequent shortages because it’s not profitable enough for drug companies to make on a constant basis. 

Like I should not have to contemplate buying sulfasalazine online in the event a shortage runs too long here. 

(I just got it refilled after a shortage that lasted a few weeks but I’m still mad)

[doctorfoxtor]

surprise bitch. bet you thought you'd seen the last of me

100 days of productivity

day 23

CVS/RS

AS has the worst prognosis when associated with LVD (AS+AR has a poor prognosis but not as bas as AS+LVD)

in acute mitral regurgitation, tachycardia actually reduces the volume of the regurgitant jet (so don't give BBs/CCBs)

PEFR specifically works as an indicator for large airway disease

acute pericarditis, normal kidney function = give NSAIDs AND colchicine for 3 months (colch reduces the duration of NSAID tx); sub steroids if not tolerated/not effective

coarcts are associated w/ bicuspid aorta, NF1 and berry aneurysms (and ofc Turner's)

atrial myxoma can cause PUO, afib, middiastolic murmur, clubbing

WPW assoc w/ MVP, Ebstein anomaly, HOCM and thyrotoxicosis

CNS

dorsal midbrain (medial longitudinal fasciculus) → vertical eye movements

Parinaud syndrome = MLF insult: paralysis of upward gaze with convergence-retraction nystagmus on attempted upward gaze, light-near dissociation aka pseudo-Argyll-Robertson pupils, eyelid retraction, preference for downward gaze in neutral position, papilloedema

statins may be associated with increased risk of secondary bleed in ischaemic stroke → commence statin after 48 hours after symptom onset

meningococcal meningitis: benzylpenicillin > III gen cephalosporin > chloramphenicol

for ischaemic stroke affecting the proximal anterior circulation ONLY, consider thrombectomy either alone (if between 6-24 hours after symptom onset, including wake-up strokes, AND if parenchyma is salvageable) or with thrombolysis (if confirmed within 4.5 hours of symptom onset); thrombectomy can also be considered in proximal posterior circulation strokes but not as strong evidence

Endocrine

to prevent refeeding syndrome, give at most 50% of caloric requirement in the first two days

to prevent adrenal insufficiency, pts on long term steroids should *double* their doses in periods of intercurrent illness

Rheum/Derm

Still disease: nonbiologics → anti-TNFs → anakinra → rituximab

Sjögren's → assoc w/ Raynaud's, RTA, sensory polyneuropathy

monomorphic papular rash without vesicles, cysts or comedones on chest and back (esp. after starting roids) = drug-induced acne; withdraw offending drug

DILE: skin and pleural involvement are common, with possible myalgia, arthralgia; nephritis very uncommon

AnkSpon: syndesmophytes = ossification of annulus fibrosus

Schober test → locate L5 on patient's back; mark one point 5 cm below L5 and one 10 cm above; measure the distance between the two points; ask patient to touch toes with knees straight; measure the distance between the two points; positive test <5 cm of increase in the distance (sign of AxSpA)

GIT

PSC: 75% are assoc w/ IBD (either occurring before or after intestinal symptoms); also, more than 20% proceed to develop cholangiocarcinoma

IBS + iron/calcium deficiency, especially worse during or after pregnancy → HUGE red flag for coeliac

s/p needlestick w/ confirmed HCV+ pt's fluids, do monthly HCV RNA testing, and the moment it turns positive, slam them w/ IFN+ribavirin OR sofosbuvir-velpatasvir-voxilaprevir; if done quickly enough, has a >90% likelihood of cure

ulcerative colitis → goblet cell depletion on biopsy is specific

Onc/Haem

vocal cord palsy due to nerve invasion is a contraindication to resection of a Pancoast or thyroid tumour

shelf lives of blood products: platelets = 5 days; RBCs = 4-5 weeks; cryoprecipitate/PCC/FFP = 2 years

cryoprec is used to replace fibrinogen, indicated when serum fibrinogen <0.15 g/dl

hu painful is it? → anti-Hu = painful sensory neuropathy ± cerebellar signs (SCLC, sometimes neuroblastoma)

reflexes like a yo-yo → anti-Yo = cerebellar signs (ca ovary, ca breast)

ripid eye movements → anti-Ri = opsoclonus-myoclonus (neuroblastoma***, ca breast, SCLC)

purkipheral neuropathy → anti-Purkinje cell = peripheral neuropathy (ca breast)

muscle riGADity → anti-GAD = diffuse hypertonia (ca breast, ca colon, SCLC)

Renal/Biochem/Toxo

activated charcoal may be useful in aspirin poisoning beyond the described 1-hr point as aspirin absorption actually slows down when ingested in large quantities and persists in the gut for a long time

peritoneal dialysis peritonitis → CoNS (esp S. epidermidis) > S. aureus

Immuno

Neutrophils Love Cheddar Cheese → neutrophil disorders are Leukocyte adhesion deficiency, Chédiak-Higashi, Chronic granulomatous disease

Some Call B-cells Brutal → B-cell disorders are Selective IgA deficiency, Common variable immunodeficiency, Bruton's agammaglobulinaemia

diGeorge is a pure T-cell disorder (that may in turn lead to secondary B-cell dysfunction)

BuT Her Son WAS Ataxic → combined B/T-cell disorders are Hypermacroglobulinaemia, Severe combined immunodeficiency, Wiskott-Aldrich Syndrome, Ataxia-telangiectasia

in immunocompromise, give abx for otherwise 'benign' conditions anyway (eg, mild Campylobacter diarrhoea in a pt taking biologics—tx as if severe w/ macrolide)

[megashadowdragon]

It has been called many things- the unwalkable disease, gutta (drop), podagra, arthritis of the rich, and the disease of kings (which sounded suitably dramatic for a title).

But we more commonly call it gout.

Doran Martell suffers from an advanced stage of gout, perhaps even exaggerated, since he has had his movement restricted to such a degree that nearly all motion is difficult without severe pain. (I'm not a doctor so, I can't say for certain)

Gout as a Facet of Doran's Character

We know that Doran is in constant pain, that it prevents sleep, and he finds no hope in medical treatment curing his disease.

The prince turned his chair laboriously to face her. Though he was but two-and-fifty, Doran Martell seemed much older. His body was soft and shapeless beneath his linen robes, and his legs were hard to look upon. The gout had swollen and reddened his joints grotesquely; his left knee was an apple, his right a melon, and his toes had turned to dark red grapes, so ripe it seemed as though a touch would burst them. Even the weight of a coverlet could make him shudder, though he bore the pain without complaint.

For comparison here is a testimony from a patient with gout in a single leg:

"The patient goes to bed and sleeps quietly until about two in the morning when he is awakened by a pain which usually seizes the great toe, but sometimes the heel, the calf of the leg or the ankle. The pain resembles that of a dislocated bone ... and this is immediately succeeded by a chillness, shivering and a slight fever ... the pain ..., which is mild in the beginning ..., grows gradually more violent every hour ... so exquisitely painful as not to endure the weight of the clothes nor the shaking of the room from a person walking briskly therein."

That is what Doran endures each day, constantly. Even the weight of a sheet would make the man shudder.

It is no wonder to me that he loves watching the little children splash and laugh and play in the Water Gardens. I imagine each glance must be bittersweet- imaging a time when he could run and splash with the other children, or watching Oberyn and Elia do the same. Knowing that now, his mobility, his autonomy has been taken from him, just as his siblings have been taken, leaving him unable to move, and unable to act.

Doran must be quite aware of how the children view him, and he takes special care to put them at ease, even at his own increased pain.

Then nought would do but he must say farewell to several of the children who had become especial favorites... Doran kept a splendid Myrish blanket over his legs as he spoke with them, to spare the young ones the sight of his swollen, bandaged joints

That splendid Myrish blanket sounds heavy with adornment (or even fabric) knowing that even a light coverlet's pressure pained him before this must be agony. It is my opinion that this blanket is as much for Prince Doran as it is for the children. He invites many children to the Water Gardens, a virtual safe haven free from class differences, a near oasis, the Prince entertains them, and it seems he must speak with them and come to know many of them. So much so, that he must say good bye.

Prince Doran carefully guards his image, this is part of the reason they left Sunspear nearly two years ago- he was getting sicker and needed to retreat from the whispers that filled the Shadow City. In the Water Garden's he is better able to project strength and wellness- his people clearly are unaware of how far his gout has progressed.

That this performance also extends to the children speaks to some form of painful self awareness on Doran's part- he doesn't want to expose his legs and upset them. I think he also doesn't want to see the children's faces and face their questions if they saw his legs.

Mobility and Autonomy

Something as simple as walking, is a thing we often take for granted. Doran can't get up to pour a glass of water, he needs help sitting up each day, he cannot support his weight enough to stand. It's paralyzing, it shrinks your perspective down to minute motions where every move is weighed by how much pain it will cause.

I think we can see this same restriction in his political moves as well- a painful reflection of his limited physical autonomy.

Hotah slid his longaxe into its sling across his back and gathered the prince into his arms, tenderly so as not to jar his swollen joints. Even so, Doran Martell bit back a gasp of pain... Hotah bore him up the long stone steps of the Tower of the Sun, to the great round chamber beneath the dome

The Prince of Dorne had to be carried from his seat, in the arms of his guard, up the steps of a tower to his bedroom. For a man in such a medieval martial society, that frames its conceptions of strength over acts of physical strength and war, which scorns physical disability, this must be a humiliating experience.

A Thimble of Poppy

It's after this day of bad news, of constant increasing pain, that we finally see a true crack in Doran Martell's armor. First the letter, which brought news of his brother's death, then his nieces repeated threats and calls for war (Obara, Nymeria, and Tyene), and humiliation from each we see him ask for a thimble of milk of the poppy. I'm not certain why, but these words (even after watching Maester Caelotte worry over possible poisoning) were very sad to read.

Doran has reached a wall, a point where he doesn't care anymore about keeping a clear head and frame of mind. He just wants relief, that constant spike in every joint, to be muted and fade to the background for a while.

Treatment

It seems that his gout has grown quite worse in the last few years:

Two years ago, when they had left Sunspear for the peace and isolation of the Water Gardens, Prince Doran’s gout had not been half so bad. In those days he had still walked, albeit slowly, leaning on a stick and grimacing with every step

Although gout has been treated in our own history for more than 2,000 years, it does not appear that the more advanced medicine of westeros (compared to our medieval history) has developed even basic treatments.

Since the time of Hippocrates we have known that gout was linked to lifestyle, and since Galen we've known that there are genetic factors associated with its development. For both of these periods gout was treated with a flower called the Autumn crocus- a powerful purgative (colchicine) was derived from it.

Strangely, there doesn't appear to be much help for it in westeros.

Maester Caleotte remained behind. “My prince?” the little round man asked. “Do your legs hurt?” The prince smiled faintly. “Is the sun hot?” “Shall I fetch a draught for the pain?” “No. I need my wits about me

In my opinion, this implies that the treatment automatically given is milk of the poppy. A pain reliever which would impair Doran's judgement- and milk of the poppy seems to fit (barring a more specific remedy we haven't heard of).

We also have reference to:

the maester helped Doran Martell to bathe and bandaged up his swollen joints in linen wraps soaked with soothing lotions

Although, I don't expect Hotah to be knowledgeable about the exact methods the maester uses to treat Doran- Hotah is in the third best position to know how the Prince is being treated (after Maester Caelotte, and Doran himself).

Lifestyle

Doran does not appear to have been given treatment options regarding his lifestyle.

A serving man brought him a bowl of purple olives, with flatbread, cheese, and chickpea paste. He ate a bit of it, and drank a cup of the sweet, heavy strongwine that he loved. When it was empty, he filled it once again.

This is, perhaps, the worst dinner Doran could have eaten in regards to his gout. Yet, it also is terribly mundane (by which I mean- likely a meal consumed regularly and not an indulgence). It is a staple meal- flatbread, cheese, and hummus. Simple, and certainly not King's Landing fare. But it is loaded with sugar, salt, and alcohol. All things which make gout worse- much worse.

We have another example:

He had decided to break his fast before he went, with a blood orange and a plate of gull’s eggs diced with bits of ham and fiery peppers

This is just as bad- sugar and meat- another food which exasperates his condition. One of the first lifestyle changes used as treatment was the elimination of alcohol, sweet foods from the diet.

It doesn't appear that Doran is remaining sick with gout to raise his popularity (as it was in our own history)

Gout (Everyone's Doing it These Days)

"The common cold is well named – but the gout seems instantly to raise the patient's social status", and to another in Punch in 1964, "In keeping with the spirit of more democratic times, gout is becoming less upper-class and is now open to all ... It is ridiculous that a man should be barred from enjoying gout because he went to the wrong school."

Nor does it appear that the gout is being used to ward off other more serious diseases (the gout seems extremely concerning)

In earlier times, attacks of gout were also seen as a prophylactic against more serious diseases. According to the writer Horace Walpole, gout "prevents other illnesses and prolongs life ... could I cure that gout, should not I have a fever, a palsy, or an apoplexy?"

My Takeaway:

I took a course on the intersection of disease, medicine, and history a while ago as a fun class- after reading this chapter again (Hotah I AFFC) I don't find him boring or lackluster anymore. If anything, Doran is incredibly human, and extremely relatable once you break him down.

He lives very much inside his own mind, I imagine wherever he is, Doran is always in the Water Garden's in his own head, seeing himself, Elia, and Oberyn shouting and splashing, as they were never able in childhood.

(Note: This is all said in the context of this one chapter, I haven't reread the next in the Dorne storyline yet.)

comments : I am not a medical student, so probably take my words with a grain of salt. Based on the source I listed below, it’s very universally known that sweets, alcohol, and meat (even sugar from fruit) exacerbate gout. The “drops” (Uric acid that builds into crystals in joints) is worsened by large amounts of sugar. (Like in the strongwine that Doran enjoys)Cherries do have sugar, not as much as other fruit, but I think they might have been referring to a combination of cherries and allopurinol which is used to reduce the amount of uric acid.Some older treatments of gout (that originated in the 19th c) basically attempted to purge the body of uric acid through urine. To my knowledge they use other methods today, but it must have been at least mildly effective (I remember reading about negative effects of such purgative treatment- so I’m not entirely sure).

[huntershowl]

@alreadybrcken​ said:

( DANCE ) leaning in closer while they are slow dancing with mine. Bc we talked about that not too long ago... :))

seduction starters ( accepting )

it’s rare that hellhound needs someone else with her to do a job. sanya usually gives a kill order, she sets her rifle up across the street, and that’s that. they die. but this man is not allowed to be shot, not by persephone, especially not by hellhound. no. this man needs to die by poisoned wine at a gala, for reasons unknown to her, but the mission’s birmingham location means mordai is not available to do her usual poison work.  in order to be able to pull off the kill correctly, persephone needs someone else to distract the target while she slips a few drops of colchicine into his drink. and there is only one person in birmingham she trusts enough to partner with her on this job. thomas shelby belongs in this ballroom; he fits in seamlessly, despite his humble beginnings, and his notoriety provides enough buzz to keep eyes off of what the tall woman in a high-necked dress and gloves is doing. it would take an order from sanya to get her to wear a fucking dress. they sent it to her in a box, along with gloves and jewelry, and ada did the rest – heeding not persephone’s protests at being further dolled up with makeup and a pearl-studded bun to hide the smoke. it’s plain that she is uncomfortable in this setting. even so, she is a graceful dancer, her and thomas’s skill combined making them a sight on the dance floor. soon, you will be able to take all this shit off. soon. just kill the fucking toff. pale eyes dart over to their target, still dancing with an unaccompanied woman a few feet away without once approaching the wine table.  the only thing that breaks her concentration is the gentle feeling of thomas leaning closer as the music slows, the movement quickening her pulse and hitching her breath – focus, hellhound. but it’s difficult with him so close. the thought of the kiss they shared while training, forced into the back of her mind, is hard to shake. but thomas shelby kisses a lot of people. it shouldn’t be of consequence, yet it is, even if not to him. how much longer will they be stuck like this?  ❛ go to the fucking wine table, ❜ she murmurs under her breath, forcing her eyes to remain on the target. stop being fucking flustered for no reason, hellhound, you have a job to do. ❛ shelby, he needs to drink before the party is over. ❜

[teachingrounds]

Colchicine has a narrow therapeutic window, so a person can relatively easily (un)intentionally overdose on it. Because colchicine inhibits microtubules by binding selectively and reversibly to tubulin, it affects rapidly dividing cells throughout the body, such as the lining of the gastrointestinal tract, the liver, and the bone marrow. There are three phases of colchicine toxicity: 1) 10-24 hours after ingestion: GI upset (abdominal pain, nausea, vomiting, diarrhea). Rx: Supportive care only; there is no specific treatment or antidote, and hemodialysis does not remove the drug. 2) 1-7 days after ingestion: multi-organ dysfunction, which can lead to sepsis and/or death, especially if the patient has pre-existing renal or liver impairment and/or they present late to care. Lab work may reveal increased liver function tests representing acute drug-induced hepatitis; increased INR from decreased liver synthetic function; and increased troponin from myocarditis. Interestingly, while there may initially be an acute leukocytosis, WBCs and RBCs may then drop due to bone marrow effects of the colchicine. Subacute signs and symptoms include severe cutaneous eruption, rhabdomyopathy, and/or peripheral neuropathy. 3) n+1 weeks: recovery phase. Pro-Tip: Colchicine toxicity looks much like the acute side effects of chemotherapy, due to their common target being rapidly dividing cells. See also: Finkelstein et alia. Colchicine poisoning: the dark side of an ancient drug. Clin Toxicol (Phila). 2010 Jun;48(5):407-14. doi: 10.3109/15563650.2010.495348.

[emptymanuscript]

So, uh, apparently vitamin C helps with gout. Like a very noticeable amount. 

I’m having an attack and I’m too close to my last one to take colchicine without some risk of liquifying my organs. So I went on a whirlwind tour of less sciency cures.

And I came across a “miracle cure” of Liposomal Vitamin C - this stuff:

which is available at amazon but I bought some at The Vitamin Shoppe. The miracle cure was overdosing this stuff - 10,000mg rather than 3,000mg, instant right away cure. I think the guy I first ran into talking about it said 10 minutes to zero pain and no recurrence. 

And, of course not. 

The world doesn’t work that way. 

But, while vitamin C really shouldn’t be taken in even the 3000 amount, it’s really not the most deadly thing to overdose on. Like, the more common cure I hear about all the time can literally dissolve your stomach. So....

Having done it, and it’s now been about 5 hours, I have to say, it’s a noticeable difference. I’m not cured by any means but on a scale of 0-10 - 0 being no pain to 10 being the most excruciating pain of my life - it’s dropped it from a 6 back down to a 4. And that seems pretty good to me. I will take -2 to my pain scale in 5 hours. 

I can’t recommend it to anyone. You really shouldn’t take a massive overdose of anything. And unlike Ascorbic Acid (what’s in the pills you take to stave off the common cold) Liposomal C doesn’t stall out on absorbtion so fast. So, yeah, not good for you at all. 

But... look, anyone who has gout knows what a hell experience it is. Just because I can’t recommend it doesn’t mean I think I shouldn’t share. If you do your own research and are comfortable with poisoning yourself to knock down the pain a number or two, I figure anyone going through that hell deserves to know there’s some possible merit to the idea.