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Dennicio,
I presume you take the protein supplementation for body building. Whey protein is PROBABLY better than Soy protein (never heard of both in one product though.)
In general neither should be high in purines. BUT in general, a super-high protein diet is generally not thought to be a good diet for gout. So act accordingly. Proteins of any tpes tend to break down acidically and an acidic joint and kidneys tend to more readily precipitate urates.
I cannot speak wioth authority but I would be careful of any supplementation that gives you more than 100 grams protein per day…to pick a number out of thin air.
Of course, if you are on allopurinol, you can eat almost anything you want.
Lynda,
The move has just BEGUN…I am now in possession of 2 apartments and am just getting moving quotes. I have not yet made a decision on the LP's. ANd it DOES have other ramifications, like the turntable, and a biggie: I want a Dolby/DTS theater system for video BUT only the very highest end receivers (over $1000) commonly have humble stereo phono inputs. So, WITH all these LP's I have stuck myself with Dolby Pro Logic, a 20 year old technology that generates artificial surround sound, and it detracts from the theater experience with the TV.
I'll PM you when I make the final decision. I cannot delay too long because the extra rent here tallies in at well over a $grand a month, a high price for procrastination.
How flattering, thank you.
But I don't think its possible on this Bulletin Board. Best I can think of is to put a name in the SEARCH box and it returns a Google-type result that sort of works. Maybe Keith (gout-pal) can shed more light on the topic.
As useful a site as it is, it IS a rather primitive style Bulletin Board format.
Remember the 1931 FRANKENSTEIN where the townsfolk were chasing the monster with pitchforks, axes, and torches. Your doctor should have been the one being chased.
The next time he says the word gout, he should be struck dumb.
When you start allopurinol you do not stop except for a serious hypersensitivity reaction.
But DO get a new doctor.
Do we all know the #3 killer in the United States. It goes by the purposefully cryptic title of IATROGENIC DISEASE. What that means in laymen's terms is KILLED BY DOCTORS. Any wonder they chose the first terminology?
Drgradma,
I tried to get into this thread seveal times without luck…the first three words divert to a different link (and then I found the arrow on the right which I have never used.)
Left untreated you wlll get gout from the high uric acid and probably that will damage your kidneys. Usually allopurinol is considered a kidney disease FRIENDLY drug so maybe stopping it is not good.
Since Stage 4 kidney is SO serious you will need a crack nephrologist to do the balancing act, perhaps with second opiinions along the way. I doubt you will be able to take a ueicosuric so that means your choices are :
1. Ignore the uric acid,
2. try to control uiric acid with superhuman diet,
3. go back on allopurinol
4. try febuxostat.
Sorry, I don't feel competent to make a recommendation. If it were for myself I would probably opt for #3.
But of course, the first thing to do is get your staging redone after a month or so off the allopurinol. You need to know your baseline. How are you treating your diabetes?
I do SO hope you can avoid dialysis or transplant…but many do very well with the latter.
Hii Vlad,
You make me want to book a flight to Munich next Fall.
It seems you are in the oipening salvo stages of gout…and it is encouraging that you can get a 6.3 SUA. But a no alcohol, vegan diet is tough even oif they exted Lent to a year round event. (My grandparents were Russian Orthodox and they did the same single Lent as other Catholics…40 days before Easter??? Why the other 3?)
As you moght have guessed I'm very fond of allopurinol and suffice to say it is there when and if you need it. Remember, gout doesn't go away…it only gets worse. It was after my fifth attack over a couple years that I started, but that last attack was one that Jupiter could not have hurled with his mightiest lightning bolt.
I must say, that 6 liters is impressive (17 cans) for a single day. Although at a picnic in the hot Sun and baseball etc. I put away a case oif 24…and drove home 20 miles, but then American beers are weaker than Bavarian brews. Thank GOD we get smarter as we age.
daniel,
I would go only a week, if that, on 100 mg. to ascertain hypersensitivity and then switch to 300 mg. With 100 mg. allopurinol all you will do is provoke that very high serum uric acid of yours.
It will most certainly not be good enough to use a 100 mg. dose as a treatment option. I hope you get through the month (and then another week for results) without an attack.
But I know, since you don't have your own prescription pad, you have to do what the doctor with the pen and pan says.
If you HAVE an attack call the doctor and have him phone in an Rx for colchicine for you.
Your father has to be honest with you and his doctor has to be honest with you. If you are to help you must know what he is taking and how it is affecting his uric acid level.
I would like to have him know about this site, this would help a lot? Or do doctor refer to this site for information?
The answer is a firm NO because doctors believe all information comes directly to them from God and/or Pharmaceutical Companies! There is no other route for them to learn. (Their earliest forbears weren't called Witch Doctors for nothing.)
For doctors, the internet is a means of keeping track of their billing, nothing more.
Nate are you still doing 600 mg. allopurinol? Have you checkd your uric acid recently.
Do you have a bottle of colchicine on hand? I recommend that gouties keep a bottleful of colchicine in the medicine chest for at least the first 30 years.
If you think about it, biking is probably a LOT of ankle and bunion joint work.
Sorry you're hurting…I hope this is the last one.
This is my GUESS, and it's just a guess and take it that way:
Your knee pain is not gout.
I don't know what kind of odds I'd take on that becasue it is probably a close call.
So that's my #1 guess.
#2 is that, you had gout in your knee that did permanent damage to the knee structure.
#3 is that you injured your knee and your gout is purely coincidental
Have you had an MRI done by an expert in orthopedics, knee specialty preferred? The pain from the damage could have been masked by the prednisone. How much are you currently taking?
What you COULD do, or maybe what I would do
, is to get off the prednisone and increase the colchicine. Prednisone is apt to be most beneficial with NON-gout pain, but colchicine will be specific to GOUT pain. If it gets worse it points to non-gout, if bettter it points to gout. Does that seem reasonable?(I know the thought of going off prednisone is scary, perhaps that's why its not the best idea to even start it. IMHO. One can become VERY dependent on prednisone, not unlike heroin.
)If you decide it is definitely gout, consider upping the allo to 400 mg. for a few months.
Sorry you are in pain and scared and frustrated, jon.
One final thought: When you cannot straighten your leg it is most often because something is impinging INTO the joint. I tore cartileges many years ago and whenever a piece of the cartilege wandered into that joint it would not straighten until the piece moved back out. I never had the surgery becasue back then it was a massive undertaking. The cartilege either reattached or shrank and it is rare it moves into the joint…but once in a while for a few minutes, yep…hobble hobble hobble.
cj,
I strongly recommend you DO NOT switch drugs at this time because it will only throw more confusion into the equation. When you're done with the prednisone, the rash is gone, you've tested cat allergy and you've taken the allopurinol for a couple weeks and judged its effects, you'll be more able to reach a conclusion.
Is there a lot more to that Medscape article? If so I will dig out my screename and password…I must have lost the cookie. If not I'll just go with your blurb.
The first problems started surfacing with an allopurinol rash in people who had been on it for decades. Conjecturing was done that there was some sort of immune system damage. From what I recall, the non-hypersensitivity allopurinol rash is unique…and rare.
Two things had me scratching my head. A damaged immune system reacts poorly, it doesn not OVER-react, a rash is an OVER reaction. Then I started reading about the development of febuxostat at the same time, and my innate skepticism said…HMMMM! (Remember the great song. “Thngs That Make You Go HMMM!” by CC and the Music Factory.)
toetrauma,
You've had enoough attacks to assume that you most likely need to take the pill every day. Without the allopurinol your attacks are likely to become more frequent and more severe.
One uric acid reading is not enough to have a lot of meaning, but it IS high enough for concern. Have SUA readings done every time you see a doctor for anything.
If, after a year on allopurinol you are getting readings of 3 or 4, then you can consider lowering the dosage if you wish. A lot depends on how much urate you have stored in your body's many hiding places.
But generally speaking, allopurinol is forever…even more so than love. It is the ultimate “til death do us part.”
I hope you have no more attacks…I was that lucky. But if you do, be more aggressive with the colchicine.
Even if it was from the AP is there a chance that I could still take the drug
Thank god there is an IF in that sentence because without it you would have to discontinue allopurinol, there is no doubt about it. But I, like you doctor, think it is very unlikely to be an AP rash.
Basically, hypersensitivity is evident very quickly and intolerance usually develops after MANY years. So your being in-between points away from an AP problem. I am happy you continued taking your 300 mg./day. If the rash goes away and stays away I think you can dismiss it from your mind.
You MIGHT want to confront your cat allergy again and see what develops? Or ask your doctor to do a cat allergy scratch test on you?
And rolling around on a bed is SO much more comfortable than rolling on a rug…with or without pussy.
I wish I could be more helpful but the casues of RASH are SO omnipresent that even skilled dermatologists just go from one drug or another…try the antibacterial…try the antifungal…try the anti-yeast…try the anti-allergy…try eliminating, foods, soaps, drugs, people, pets…then start over with a NEW antifungal, etc.
But I gave myself an idea…try Benadry. It's OTC and try using divided doses totalling maybe 100 mg./day for several days. If it works, it helps prove a histaminic allergic reaction to something. It WILL make you sleepy, so dose accordingly. No high wire acts or driving a tank (the ultimate “heavy machinery!”) A 50 mg. dose before bedtime is a decent sleep aid.
trev,
I usually teetotal for at least 6 months every year…always January 1 to April 1 and then several shorter periods, usually a month , scattered throught the year. By March 1, I can throw away my BP meds, but that takes 2 months. (I've been doing this routine since 1987.)
This year has been unique in that I am being tortured by a home moving crisis that goes on and on and on and on without resolution. When it comes to an end SOON I will sedate myself with valium for a week and call it quits on the booze for a LONG time.
When I am off the sauce it is totally off with nothing more than an occasional Bouef Bourguignon or a Chicken Marsala.
My local liquor purveyor will probably commit suicide.
If I could drink only a little every day, I would be happy because it raises my HDL a lot (got a 45 last week!!!) and I DO have cardiac concerns. Without any booze I can slip down to 28…that earned me a stent.
But I cannot drink in moderation so I do what I gotta do.
Do what I said in my first post: buy a tube of 1% hydrocortisone cream and apply it to your rash daily now, and a couple times a week afterwards. If it recurs, use it some more.
The cost is $3 bucks or so, and it is FAR less dangerous to use a corticosteroid locally than to fill your body with it orally or parenterally (by injection.)
Prednisone works for almost ALL rashes regardless of cause. It is the ultimate “symptomatic treatment.”
Between the cat and the poison ivy, your girlfriend seems a danger to your naked body, cjeezy.
To post a picture, use that TREE symbol in your reply taskbar.
Don' worry too much about penicilln sensitivity and the uricosurics. More concerning would be a sulfa allergy, but even then the risk of hypersensitivity reaction is small.
As for the 27 deaths in all the world for the half century of allopurinol, it is probably lower than the deaths from a reaction to M&M's.
To put it in perspective:
http://www.medicine.ox.ac.uk/b…..hyper.html
cjeezy,
You will find that interesting. Of the 100's of million doses of allopurinol prescribed through 1990, 127 cases of hypersensitivity syndrome resulting in 27 deaths were reported. This is from the literature of the entire world.
Note also, that the rash f alllopurinol hypersensitivity is almost ALWAYS (95%) associated with fever.
(It's the pussy cat.)
The rash of alopurinol is usually described as maculopapular and here's a sample, a slightly raised red patch with a bump in the middle:
Buy a tube of 1% Hydrocortisone…usually $2.99 at a discount pharmacy or supermarket. Apply a little twice a day.
Without health insurance doctors' visits are getting prohibitively expensive.
Remember, we take allopurinol all our lives and people who don't take it have a 99.9% chance of getting a rash from something unless they die in the cradle.
I don't know what an allopurinol rash looks like but it usually occurs, when it rarely does, after many years of treatment. If you see any hives, or lip or eyelid swelling, then stop the treatment ad consult a doctor, although all can be casued by the common cat allergy. Does the rash itch?
Allopurinol may cause rash with both raised bumps and flat discolored areas (“maculopapular rash”) in 1% to 3% of people.
Not so serious but it could presage other developments, diferent kinds of rashes.
I started on 400 for a year, went to 300 mg. for more than a decade. Decided to do 200 for the better part of a year (and my doctors prodding), but some toe twinging and a 6.7 SUA sent me back to 300 mg. where I will remain “til death do us part.”
My Foot Hurts,
Give it a year at these 3.5 readings to clear out a reasonable amount of urate. I recommend you stay at 300 mg. allopurinol becasue it is working very well for you, and it is the dose that most people find works best.
How long will you be in “maintenance”?
…for the rest of your life!
But there are worse things than popping a cheap pill a day!
It's probably the meter.
DO the instructions list the lowest recognizable level with the test strips?
In any case, I doubt that short term ZERO uric acid has any notable untoward consequences. Would that we could all have about a month of it every year to clear out the detritus.
Of course, if you have been turned to a vampire overnight, all bets are off.
I have just read an article on differential treatment of gout and the preferred method for using prednisone is by injection into the afflicted joint if only one joint is affected. With more than one joint, then the oral is the better route. Seems to make sense to get the most antiinfammatory drug INTO the inflammation site. Why treat your head, heart, liver and kidneys when your FOOT hurts?
Get to 400 mg. allopurinol as quickly as possible and test your SUA after a couple weeks. Depending on that number, go from there. The longer you hang at 100 or 200 mg,, the longer you will prolong your pain.
The best oral drug for an acute attack is still colchicine and the second indomethacin (ignoring narcotics that is.) The only reason colchicine is superceded with less effective drugs is that for some silly reasons doctors think they will be sued for malpractice if someone gets diarrhea??? Go figger.
Suffice to say that your uric acid levels are very high and it may take more than the normal 300 mg. allopurinol to get them down to the 5 level. Once you start the allopurinol NEVER stop it, attack nor not, unless you show a serious allergic reaction (swollen lips and eyelids, throat closing down, difficulty breathing…called angioedema. Hives are another syptom to beware.)
Allergic reactions to allopurinol are rare.
I really like a start of 300 mg. to start, but at least the 100-200-300 progression is better than nothing.
Alas 100 or 200 mg. allopurinol will not help with a 10.8 uric acid/
The faster you get to 300 or 400 mg. allopurinol and an SUA below. 5 the better. Honest, 100 mg will do more harm than good.
An aside: I am beginning to question the old saw about waiting til the END of an attack to begin allopurinol. I'd like to see some proof and I am getting tired of ancient accepted wisdom based on nothing,
“Hey guys, mercury is deadly poison so lets put it in every kid's mouth!” Wrong, it's a POISON!
“You have an ulcer, what you need is a milk diet”…Wrong, you need antibiotics for an H. pylorii infection.
“Oh, George Wahington has the flu…Let's BLEED HIM!”…Nope, you killed the first U.S. president.
Knees are funny. It is not easy to tell a gouty knee from a torn meniscus ir a famaged cruciate ligamnet from osteoarthritis…these can happped totally independent of gout to a person with gout.
You could try 400 or 500 mg allopurinol for a couple months, especially since you do not know your uric acid level. Try colchicine for pain relief, do not be afraid of 12 or 16 in a day especially if your livelihood depends on stopping this attack.
If Diclofenac isn't working try Aleve or Indocin.
Get your uric acid tested.
So glad to hear you are doing so well David.
One bit of advice, why not give soccer a wide berth for another year.
For the population of India, the slice is small: many vegetarians.
If you had a Spanish site I'm sure all-meat-all-meals would put Argintina way up there.
State by state would be interesting: I vote for the NYC metro area (NY, NJ, CT)
Perhaps the U.S. numbers are so high is that unemployment is running rampant, hence more time for the internet.
Aleve, though of minimal side effects compared to many pain killers, is aspirin based.
I doubt that very much trev. They are chemically as different as night and day. Do you have a reference?
Odo,
Thanks for filling out the Lancet reference. Good stuff. I'll bet it pissed off Takeda Pharmaceutical to read that.
As for adding to the database, it require gout-pal's wearing a pointy blue cap cap studded with stars, a wand, an incantation, and few sprigs of henbane or eye of newt… I get confused which.
5. Apparently 90% of gout cases are treated by primary care doctors, who under-treat the disease (e.g. don't prescribe high enough allopurinol dose) and aren't particularly up-to-date on the disease. This is claimed to be one obstacle to development of more effective gout drugs – drug companies aren't sure there's really a market here.
Oh yes, oh yes, OH YES! As each and every new $$$$$$piricey$$$$$$ drug reachhes the market the only way for them to sell it is to denigrate cheap wonderful allopurinol. Lancet got the first sentence precisely correct and hedged on the second. THe second, for honesty's sake should read “Properly prescribed allopurinol works well and thus for any new drugs ”drug companies aren't sure there is a market there” for medication costing 20 to 100 times as much.
Until febuxostat was started in development one never read a WORD about the problems with daily allopurinol. All of a sudden the propaganda started coming out…I've read a LOT about allopurinol for many many years and it was always described as one of the safest drugs in the pharmacopeia. Had me scratching my head until a couple years later TADAAAA: febuxostat. Cause and effect in neon lights.
I would bet half my scrotum that several/many doctors were “paid” for their excellent opinions of the new drug and of course, those opinions make no sense unless allopurinol is dissed: “side effects, allergic reaction, doesn't work well, let's start you on 100 mg,” and on and on. Of course many doctors are merely paid a “premium” to prescribe certain pricey drugs…the same story hits the news every month, only the names of the doctors and drugs change names.
As for #1:1.
Cheap Colchicine will leave the market this year. A company called URL Pharma has secured 3-year exclusivity for colchicine, now branded as Colcrys, and will jack the price to $5/pill.
Somebody BIG at the FDA was bought and paid for plain and simple. He should be uncovered, charged with bribery and fraud, and sent to prison for 20 years. Those at the drug company who did the bribery should be charged with runniing a criminal enterprise under the RICO statutues.
Anyone who hasn't yet gotten his stash of generic cochicine should ask his doctor for 60 post haste.
