His big toes were swollen , could hardly walk. He knew when his gout flared but he was frustrated because it was happening more frequently than the previous years. He threw the towel and decided to finally seek medical care when he started to have pain and swelling in his elbows and wrists. He then came away with two more diagnosis, hypertension and kidney disease.
So there he was sitting in front of me with his wife and a bunch of papers, some receipts of recently purchased medications and labs that showed kidney failure and high uric acid.
I reviewed them quickly.
What brought you here?
“They called me to come see you; for kidney or something,” he said hesitantly.
“And my blood pressure,” he added.
So you have gout?
“It is bad,” he said, showing his swollen elbows, wrists and toes.
What do you take for the pain?
“Nothing works. I tried Tylenol, Aleve.”
He looked at his wife.
“Just tell him,” she said.
“I drink a little something for the pain.”
The triad of gout, hypertension and kidney disease was enough for me to cut the chase.
Do you drink moonshine?
When I saw a bit of a surprise on their faces followed by loud laughters, I knew I was in to something.
“Once in a while, it is hard to get it around here,” he said, lowering his voice.
“That is the only thing that takes away his pain but the gout keeps coming,” she added.
Moonshine is an alcoholic beverage often brewed illegally in many parts of the world. In Africa it takes the lion’s share of the alcoholic industry. It has different names in different parts of the world. In Kenya for example it is called “Kumi Kumi” or “kill me quick”. It is widely brewed throughout Ethiopia and known in many places as Arake. I remember grandma allowing us a sip when we had stomach ache…a belief that it killed germs. I remember retirees in the neighborhoods killing some time and the stress off over cups of Arake, some with canes nursing swollen joints.
Moonshine is hazardous. It can be contaminated with metals such as lead, particularly if radiators are used as condensers. It can also be contaminated with toxic alcohols such as methanol. When lead is consumed even in small quantities, it competes with uric acid for elimination through the kidneys leading to elevated levels of uric acid in the blood. High uric acid is a risk for gout. High uric acid has also been associated with elevated blood pressure and chronic kidney disease.
Reluctant at first but a urine test of high lead levels convinced him to dump a large quantity of moonshine that he purchased in the blackmarket and stashed in his bedroom.
Over the next 6 months we were delighted to see a simple intervention making a big impact; his uric acid levels decreased, the joint pain and swellings markedly improved, his blood pressure was easily controlled and his kidney function stabilized.