Brief Answer:
Following suggestions to your queries...

Detailed Answer:
Hi my dear,

I have gone through your medical history carefully and feel sorry for the unpleasant situation you are in.

At the same time, I am happy to hear that chest/back X-rays and lumbar/thoracic MRI's, ultrasound, CAT scan, and other tests revealed nothing of significance.

Suffering of gout itself is associated with continuous/intermittent joint pains due to deposits of uric acid in the joint's liquid (called also "gout arthritis").

So, it is very important to keep monitoring your blood uric acid. Apart Uloric (medicine), it is crucial to follow a healthy diet always in order to prevent gout attacks and further damages to your body.

Next, another problem I have noticed is related to GERD and hiatal hernia. If I was your caring doctor would advise to keep regular follow ups to see if size of hernia is changed in order to take proper measures. With regards to GERD, I think it is well controlled with Dexilant use. It is also important to :
- follow a healthy diet
- avoid alcohol, energetic drinks, etc.
- use extra pillow when sleeping
- take medications as prescribed
- consume more water
- do not lay down immediately after eating

At the end, you are concerned about Lyme Disease. It is true that chronic Lyme disease might cause "Post-Treatment Lyme Disease Syndrome". Recently, a two-tier tests are recommended for Lyme disease. You can discuss it further with your doctor. Depending on these tests results, specific management strategy would be described.

Please find the recommendations at the following link:
http://www.cdc.gov/lyme/diagnosistesting/LabTest/TwoStep/

Hope it was of help! Let me know if you have further questions!
Dr.Albana

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