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[[File:A physician advising his reluctant patient to avoid alcohol Wellcome V0011382.jpg|400px|thumb|left]]
'''Gouch''' is a recurrent inflammatory arthritis so painful that "ouch" is built into the name.<ref>[http://gomerblog.com/2015/08/gout/ Patient Continues to Insist He Suffers from “The Gouch,” Not Gout]</ref>
'''Symptoms'''
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'''Gouch''' usually manifests first as podagra: a red, hot, swelling, and [[Annie Hallux|painful big toe ]] that makes "walking a bitch." It often happens in the middle of the night for the simple reason that '''gouch''' is evil.
'''Causes'''
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Old-school thinking attributed '''gouch''' to elevated uric acid levels due to [http://gomerblog.com/2015/08/alcohol-abuse/ alcohol], [http://gomerblog.com/2015/01/obesity-epidemic/ red meat], and [http://gomerblog.com/2015/05/protamine-shortage/ seafood], with crystallization at lower temperatures. New-school thinking simply attributes it to the [[Dr. Oz|Devil]].
'''Differential Diagnosis'''
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[[Chest X-Ray|Pneumonia]], [[TIMI Risk Score|STEMI]].