Keith’s GoutPal Story 2020 Forums Please Help My Gout! Self surgery on Gouty Tophus

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  • #3132

    HI, new here, and what a great site!

    A bit about me, 38 years old, and first got ‘the gout’ about five or six years ago – both big toes in the toe, not at the joint where the toe meets the foot.

    Anyway, when I first got Gout, weighed in at about 120 kg, and was on allopurinol etc, but am on no medication now, as have lost a heap of weight – currently 93 kg, and have taken up bodybuilding in the last year, so weight goes down to 78 kg on competition day (will be more now after a good off season, but I digress).

    Anyway, I dropped a weight plate the other day, it rolled along the floor, and then fell on my right big toe, which since swelled like a balloon – first serious gout pain for a loooong time.

    So being a typical Kiwi bloke, (and having done this before), I got a needle out, poked the toe (you have to do two holes I have found out, one doesn’t do the trick), and squeezed – with the ‘tiny white maggots’ coming out in droves – the uric acid crystals I assume?

    My doctor has previously cut the toe open and pulled out heaps of is it called tophus (I love google, have found out heaps on this, and found this site in fact) – so I poke the needle into the scar, one at each end.

    At this stage, no infection, no pain in the toe, as the pressure is gone, and draining the gunk twice a day.

    So anyone else tried the self surgery method…?!?

    Can you drain gout?

    There are risks in draining gout in this way.

    1. Infection risk is extremely high.
    2. Wounds might not heal.
    3. It is impossible to drain all uric acid crystals without surgical lavage procedures.
    4. You’re doing nothing to prevent recurrence.

    For more insight see What do Uric Acid Crystals look like?

    If you or your health adviser has allowed your gout to get to the point where you need to drain gouty tophi, you are a Gout Victim. Depending on the reasons why tophi have developed, and your personal views, you might easily start a different plan. So I strongly recommend that you read Questions for Gout Sufferers now.

    Can I remove tophi myself?

    If you want to discuss removing your tophi, please use the new gout forum. Especially, squeezing gouty tophi.
    See Tophaceous Gout Facts


    Photos or it did not happen :-)

    Least you should do is disinfect the needle before doing such things. I have a tiny lump or cyst accordign to Google in my ear lobe for last few months. Non Gout related I hope and am tempted to stick the needle in and see what if anything comes out.


    lol, I'll take some photos tomorrow at my lunchtime 'squeeze'!!

    Good dark red blood still coming out at the squeeze too, and no hot infection feeling.  No doubt local doc will have a good laugh if I do come down with an infection, but touch wood, cross fingers and all that, I won't!!

    and my left toe, which never got as deformed is still good as gold.



    I always suspected too many sheep would drive a man crazy.


    I've done it with a thumb,

    PLEASE be careful…if you get an infection in that joint you will be SO sorry. Clean area with soap and water and alcohol before poking and then rub on an antibiotic cream afterwards.

    I always suspected too many sheep would drive a man crazy.

    Depends on what you use them for.


    BartMan said:

    My doctor has previously cut the toe open and pulled out heaps of is it called tophus (I love google, have found out heaps on this, and found this site in fact) – so I poke the needle into the scar, one at each end.

    Seriously, you're only 38 and already had surgery to remove tophi? Ouch that sucks!!!

    Richard Bell

    Guess I’m just lucky but I haven’t had to do surgery on the tophi on my toe and ears. At the height of my attack they had openings of their own that the crystals and brownish liquid drained out of without any help on my part. Now the tophi on my ears are gone and the hole in the tophi on my toe has healed and the tophi is greatly reduced in size. I did use antibacterial cream on them while they were draining. I’m on 80mg of Uloric and drink about 5 liters of water a day. I also take a half teaspoon of baking soda in 8oz of water before going to bed and after five months I am now improving greatly.


    BartMan said:

    So anyone else tried the self surgery method…?!?

    BartMan, yeah, you got company in your boat. I had first a friend doing the needle poking trick, but then I did it myself for several days on my right index finger, ( after a couple of weeks of not even been able to hold a piece of paper between thumb and index finger. Whole right hand was out of commission for more than 4 weeks, swollen like a balloon with 4 out of 5 fingers in pain, having joined The Untouchables.) I'll get you a photo, vegieGuy, of what my finger looks like today

    To put your minds at rest, vegieGuy and zip, my gas stove does a beautiful job of disinfecting a needle, almost as good as UT.

    I performed a second brain-surgical job on my gouty right foot bunion a week ago, which is now bigger than when it was first surgically removed 15 years ago. Only problem: Brain was lacking. Didn't have BartMan's brain to pock two holes into the accumulation of diamonds, I mean, uric acid crystals. But Mother Nature, smarter than I, came to my rescue. She only needed ONE hole to squeeze the  'tiny white maggots' out in droves.

     And again guys no worry, so far no infection. I got one of Mother Nature's own antiseptic concoction, engineered by me: a volcanic ckay (Ca Bentonite=Montmorillonite [this is another can of worms, I better not open here]), grapeseed oil, and dist. water. This paste keeps the bugs out and the maggots in till I let them out again during the day time.

    Short interruption: I just removed pad with paste and the photos should show Mother Nature's power at work.

    GP, how can I get a photo on here?


    Hey Cjeezy – I am guessing about the tophi – does that have to be hard – or the 'tiny white maggots', as that is all that he found in there.

    Glad I am not the only desperate man with a needle.  Yes, I clean and use antiseptic creams etc too, and keeping touching wood, no infections, no pain, and another good eruption this morning.  I must be a goul, or should have been a doctor, I love this 'self treatment' – whcih is a bonus, something 'good' out of this bad situation!!

    although looking at all the photos on google has been turning my stomach  – there is always someone worse off than you, in everything in life eh!


    and this battle is won – no longer red and angry looking, and nothing left to squeeze outLaugh

    so this battle is won, this time.  Must be more careful with the weights in future, as this was just dumb – from the weight to the needles…!!


    hansinnm said:

    GoutPal, how can I get a photo on here?

    How to upload pictures (tech stuff forum)


    Bartman, Poor old GP, now he is dealing with two odd bods from the  lands down under. The other Northern Hemisphere bods, will be doing on going Wikipedia searches for word meanings.

    Have a look at my Epsom Salts bath trick under Cures, posted today. I don't intend to attempt the needle trick, I'll leave that to you.Laugh



    Tophi do not have to be hard, firm though. THey tend to blanche white for a moment or two when presseed.

     THe crystals are mixed with pus, joint fluid, fat and the result is something slippery and creamy almost like a thick white salve. THat's been my experience. Is that how you would decribe your “maggots?”

    I will soon attack a small one on my little finger (my only known remaining tophus, at least that is visible.) But not to sound like a broken record there are three words to remember: STERILE, STERILE, and STERILE. I also would never go INTO a joint but rather wait until the tophus rises to just under the skin and looks like it is TRYING to get out. Picture coming as soon as I go shopping and find time to set up the camera.


    ok, must not have been tophus then – as nothing coming to the surface (like the photos I have been seeing on google), just deep inside the bunion after I poke!  Clear fluid filled with the 'maggots' is the norm.

    I'll have to take some photos next time – although last time was a few yearas ago, lets hope next time will be a few years too!


    Just the word “maggots” makes me cringe.Yell

    Jeff B

    Tophi Removal?

    What are the circumstances that would require tophi removal, and is it advantageous to get the little buggers removed? If these things are little mines of urate crystals, then why not have them surgically removed from the situation?

    I have developed what can only be described as a ball of tophi at the end of my right big toe. It looks like a half marble sized ball that is hard and painful to the touch. This is also remarkably close to the joint that has given me 99% of my attacks over the last few months. Remove the gout mine, and remove part of the problem?

    It seems logical in my mind. Understand that I am an athlete, so going under the knife is not my first preference.


    You are right.

    But the reason they aren't removed until they get grossly big and interfere with a joint is that all surgery carries the risk of infection/allergic reaction to anaestehtics/death.

    With gout, perhaps there has been experiences where removal of most of the tophi exposed the remaining urate and caused horrific attacks after being sewn up.

    If your stomach is strong:

    The upside of surgery is that gout seems to be deposited JUST UNDER the skin. The body seems pretty successful at getting a lot of this cement OUT of the joints. My only tophus, a little one on my little finger, is about 1/8 inch up from the joint (that never caused any pain.)

    Jeff B

    zip2play said:</p

    If your stomach is strong:

    Well there goes breakfast! 😳

    Richard Bell

    I had a tophi on my left big toe that made it 4 to 5 times normal size much like the photo zippy posted. I’ve been on SUA reducing med for almost a year now and that tophi is almost undetectable. Surgery is not the only way to get rid of those crystal.


    What type of physician cuts out tophi?

    I had my first Gout attack at age 27. My thirties were hell. In my early forties I started developing huge tophi in all the usual places. Mainly my elbows(the biggest) my right finger is “frozen” in the extended position, minor one on the knee, and the one I need to have something about on my big toe. I also have nodules on various limbs under the skin. My problem is that I wear a size 15-16 shoe. I cannot wear a shoe on my left foot without squeezing it on and crushing the toe. I’ve tried various shoes to no avail. My question is, who the hell do I have remove it. My idiot doctor deftly avoided the question by saying that the massive dose of allopurinol will shrink it. Well it isn’t shrinking. WHAT TO DO?

    Tophi Removal Surgery Photo

    Tophi Removal From Hand photoWould you prefer this tophi surgery on your hand? Or medication therapy that removed John’s tophi without surgery? ?:?

    Keith Taylor

    I’m not sure your doc is a complete idiot, but I haven’t met him, so I’ll reserve judgment. He’s not wrong to think that allopurinol can shrink tophi, but every case is different.

    From your information so far, I think you have had around 20 years of gout (?). I wonder, how many years of visible tophi?

    This can be a major factor, as the longer tophi exist, the more they get “locked in.” By that, I mean that fatty deposits and other crystals and dead cells can build up around tophi, so the mass becomes isolated from the blood stream. In such cases, simply lowering uric acid might not be enough. Unfortunately, you haven’t told me your uric acid level, or even your allopurinol dose, so I’m not certain that surgery is your only option.

    You need to be aware of the risks of surgery. Like all cases of gout, treatment has to balance all your circumstances. Surgery might be the answer, but it is extreme, and it does carry risks. You really must consult a rheumatologist.

    Please don’t be tempted by a podiatrist unless you have exceptional reasons to trust them. I have seen many podiatrists who have conducted unnecessary surgery after years of mistreating gout patients. Do they do this through ignorance, or for the surgery fees? I don’t know, but I wouldn’t put my life in the hands of someone who deliberately accepts unsafe uric acid levels for many years, then decides that surgery is the only option.

    Please let me know your current allopurinol dose, your last few uric acid test results and and the length of time you have had visible tophi. I might be able to suggest other treatments with more facts. However, the golden rule is: if gout is not straightforward, see a rheumatologist. That’s your best option to get rid of gout pain permanently.

    Keith Taylor

    Prompted by a current discussion in the new gout forum, I added a photo to the original post. The photograph of tophi surgery is in an archive from American Society for Surgery of the Hand. It includes a discussion of the risks of all surgery, and a particular risk of tophi surgery. Tophi surgery is unpredictable. Attempts to remove tophi might cause them to spread. This can lead to tendon damage that might be severe enough to require a tendon graft.

    That’s not to say that tophi surgery is wrong. But, as that surgery archive explains: “medical management is the first line of treatment”

    In the new gout forum, John describes his Krystexxa experience, with tophi shrunk due to medical gout treatment. Though that is not allopurinol specifically, we do discuss allopurinol, and its capacity to shrink tophi.

    If you have any concerns about tophi removal, or any other aspect of gout, please ask in the new gout forum.

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