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Nick,
Go to 300 mg. allopurinol.
With UA's of 7.2 I don't want to have to say “I told you so” when you have a major attack with pain you have probably never experienced before. Thing is that for some of us, the only way to be convinced of the severity of gout is to go through a baptism of fire, we are all human. That's what it took for me and I wouldn't wish it on almost anybody (Bush and Cheney possible exceptions
.) A gout attack that last weeks and causes COLOSSAL pain is truly awful and a good recipe to guarantee it is 100 mg. allopurinol resulting in a UA of 7.2. If you are going to take alllopurinol take the correct dose and that is the dose to give you low serum urate numbers. (In my heart of hearts, I believe that too low a dose of allopurinol is worse than none at all…but I cannot prove it.)The upside of 300 mg./day allopurinol is that you can drink 3 bottles of REAL beer every night without a second thought…except the well-known waistline effect.
How has gout changed my life?
It has made it necessary to take a pill every morning…300 mg. allopurinol.
Fortunaltey when I had my gout attacks I was driving a 25 foot long Oldsmobile with a 454 cu inch engine that drove itself. All I had to worry about was avoiding icebergs as she crusied along and I sat at the captain's table. “All ahead full!”
After allopurinol I got a 5 speed Hyundai Excel (blecccch!) and shifted with alacrity.
Jon,
Although I have no clue as to the mechanism there is the VERY often seen correllation between edema and very hot weather?
It probably has something to do wth the body conserving sodium, but don't quote me,
It is the dehydration of Southern California heat combined with humidities approaching that of the MOON. Anyone from England or the Eastern United States cannot comprehend how bone dry the air is in your area. The Mohave is the same as the Sahara.
My last extended trip out West was in a broiling hot August and I had a sore throat every morning and my eyeballs dried out if I looked at anything for longer than 3 seconds. A trip to Disneyland at 109 degrees was like a visit to Hell. I don't know people stand the bone dryness? My only relief was in artuficially humidified places or swimming pools.
So keep drinking lots of cool clear water…at least until the Colorado dries up.
Gout diets are near impossible to follow, and once I thought I knew what my trigger was, something else would trigger the gout. I believe that in my case I produce too much UA, and my kidneys do not flush it out fast enough either.
Allopurinol has saved my life in a way!
Amen brother,
Sounding biblical I say: “Blessed are they that see the light early for their feet shall stop hurting!”
What if 50% of all gout today can be proven to be iatrogenic (doctor caused?) Since 1960's diuretics have been copiously prescribed to cure a symptomless, possibly harmess “disease”…hypertension. It is not unlikely that they were the cause of the gout epidemic we have today. Find that cause and effect and the cost to the medical profession will be BILLIONS in damages! So the answer is Don't Look!
A good analogy: I read that any MENTION of damages caused by the application of mercury by the ton into the mouths of children for a century is grounds for loss of license to practice dentistry.
Further back, Copernicus was told to STOP seeing that the planets revolved around the Sun.
There are facts that must NOT be proven without infuriating powers like the medical profession, the dental profession, or GOD in order of importance.
Yep hans,
People have told me to convert to CD's, DVD's or hard drives. But then you hit the nail on the head: I'd hate to spend the entire remainder of my life trying to digitize all that info.
Also a BIG consideration is the thing that makes LP's a delight is their deliciously warm analog CONTINUOUS sound instead of the hard-edged sound of spot-sampled compressed digital music approximations. Listening to Kirsten Flagstadt or Lotte Lehmann immolating herself on an LP cannot be compared to listening to a digitized figment of her voice on CD.
Gosh, I think I just talked myself into jamming them into 15 cardboard boxes and dragging them along…the entire half ton.
AND I have another 800 CD's to go along also…lordy, and the TAPES, but only a couple hundred of them!
(I'm exhausting myself thinking)
Lyndak said:
And Zip….7-8 liters is quite a lot….even with beer included. I mostly drink filtered water with various flavors of crystal light or the Wal-Mart equivalent, which is about half the cost. Is coffee really a good drink for gout? I know that uric acid is excreeted in urine. What would happen if I only drank 3-4 liters per day? Would my A-frame fall out (ha-ha). How much fluid should we be drinking?? There must be more than one person wondering about this.
Also, I would almost rather give things away than move them!
Yes, I drink a lot but not because I force it…I drink when thirsty. Maybe being a big guy (6'2″) my needs are higher. Coffee, the jury is out: many say it is GOOD for gout; I think that becasue caffeine is a purine it must be bad. But good or bad rarely comes into play in an addiction and I am an addict. I was given coffee and a roll for my breakfast before Kindergarten. Coffee was served after every meal.
Thinking about throwing out a LOT of detritus (gosh 1,000 LP's
.)I get about 5 or 6 liters of liquid a day. Mostly coffee and tap water (at about $.01 a gallon cost to landlord
) and a can of diet soda and some of that powder mix (Diet.) Make that 7 or 8 liters if I'm on a beer kick…I am now becasue of unbearable stress of contemplating moving. The older we get the less pleasant the thought of hauling detritus from one place to another.
I think EVERY attack results in a tophus (or 20), an isolated area of monosodium urate that the body has walled off as an invader. Thing is, if they are tiny, or on the inside of a joint or under a fatty layer, they may not be visible, even to X-ray (or ESPECIALLY to X-ray.)
But when we have gout, we have tophi, and I am almost certain we will each take several of them to the grave.
Keith showed that fancy new scan (forget the name) that showed urate in a man's gouty foot and the deposits seemed to be EVERYWHERE.
No way except on autopsy will we ever know whether we have tophi in our shoulders, spines, knees, hips, etc.
God DAMN that uric acid…I hope it is good for something. (I once read that it is the singulary strongest antioxidant…I hope THAT'S good for something. I also read once that it is positively correllatable with IQ, and somewhat believable becasue only the higher primates have it…plus maybe the dalmation?????)
At that time it was 10.9 and My GP, Nephrologist and transplant Hospital all got a copy, and not one of them told me it was high or suggested that it was a problem!
That's when you must be thankful that you don't have a machine gun in the house.
Lyndak,
Let me support and amplify what trev said. Your doctor WILL NOT sign off on any strong uricosuric like sulfinpyrazone or probenecid…the high excretion of urate is NOT good for anyone with kidney issues.
Far better to use an agent that causes less uric acid to be made, and that's allopurinol or febuxostat.
Lynda,
That 2.4 drop in 8 weeks on 100 mg. allopurinol is better than can usually be expected and it is NOT enough to ward off further serious attacks. I doubt that taking more, as you must, will damage your kidney but rather benefit it. With a transplanted kidney and gout you dare not linger at 8.0. But you MUST get your nephrologist to make that call because it is too serious for internet boards.
From Medline Plus (NAtional Institute of Health…U.S. gov.)
Other uses for this medicine
Allopurinol is also sometimes used to treat seizures, pain caused by pancreas disease, and certain infections. It is also sometimes used to improve survival after bypass surgery, to reduce ulcer relapses, and to prevent rejection of kidney transplants. Talk to your doctor about the possible risks of using this medication for your condition.
Caveman,
I agree with the others that you have gout based on your high serum uric acid and the thorough response to colchicine. I can imagine the bunion stress of laying wall to wall carpeting because the big toe is not only flexed the whole time it is used to push off on the metal knee-kicker that pulls the carpet tight onto the “tackless.” I'd like to give a shot at laying wall to wall carpeting but it is getting passe these days in favor of clean shiny hardwood floors.
Very few doctors will prescribe allopurinol aftter the first attack because they assume that SOME people will have only one or two attacks in a lifetime. (Yep, and I've got a bridge to sell that connects Manhattan with Brooklyn.
)If you have only one attack a year that can be managed with colchine, low purines, cherries, black bean broth, or a trip to Lourdes you might be able to do without the “forever” drugs. But if you have 2 or 3, the drug route will probably be your answer. If you are criplled on a monthly basis then your path is quite clear, 300 mg. allourinol/day.
Personally, I think when one has his first gout attack lifelong medication becomes an inevitability. The only reason I suffered though 5 attacks before starting allopurinol was ignorance (pain was atypically in instep and ankles) and RELATIVE mildness during the first 4 that ONLY required crutches….so you can imagine what #5 was like.
Think back, can you recall any unexplained foot pain that lasted about 3 days.
Jake,
You might be on to something.
For a while I was noticing toe twinging (I don't have real attacks anymore) after a couple weeks of overdoing YUENGLING'S BLACK AND TAN.
Although it is an American beer (oldest Americal brewery…Pottsville PA) it is dark and heavy, both high in alcohol and calories and almost the color of light porter. They even do a BOCK beer occasionally which is black and almost syrupy.
So I agree that light pilsners or even the lighter LITE beers, which to me taste like high priced seltzer water and thus not for me, are probably far less likely to trigger gout.
But the Japanese doctor had a nerve…after all don't they make that ridiculous ASAHI that is full of nothing (and anyone who can stomach SAKI has no taste buds at all.
)I have used Yahoo since 1996.
I THINK I voted you up on the first question but the re-sign-in is tedious and I was surprised I had to do jump through all those hoops.
On the second question I got “sorry you must be at Level 2 to rate???????????”
I guess I now have a clue why Yahoo's stock is tanking.
For me, the pricing and “newness” have made febuxostat out of the realm of options. Of course, for gouties who cannot tolerate allopurinol, it is very MUCH an option. So there is little to debate. For me, unless a drug has been around for 10 years or more I must consider it “experimental” and experimental products have a place only if there is no tried and true alternatives.
As I have seen the the product evolve, what has happened is much what I would have expected and that included MUCH publicized and amplified side effects of allopurinol, a drug judged innocuous for decades. But little by little the liist of Uloric side effects is growing and at the current rate, it might be soon judged a riskier drug than allopurinol.
But again, until it loses patent protection and starts being priced at the same price as allopurionol there cannot be much of a debate as to which is better.
I think a reasonable analogy MIGHT eventually be the NSAIDS that were used to treat joint pain like ibuprofen, aspirin, naproxyn were all wonder drugs until they lost patent protection and were pooh-poohed by the medical profession as soon as COX-2 inhibitors hit the scene. Immensely expensive, the new drugs (like Vioxx and Bextra) were touted as the new SUPER aspirin, gentle on the stomach and marvellous at pain relief, and sold and prescribed at huge markups for several years…and then the patients started having extra heart attacks and strokes and poof went almost all the Cox-2 inhibitors.
A new expensive drug is always WONDERFUL…until it ain't.
Just to recap a point. GP said that the FDA will rule on the uricase on September 14…that's TOMORROW so lets keep our eyes peeled.
Second point (I knew I couldn't stop at one…just like a can of beer.)
Liver enzyme abnormalities: Speaking generally, they have ranges clearly shown on printouts. Let's say normal is considered 1.0-4.0. Lots of uninformed doctors panic if they see a 4.6, even though disease conditions typically show 10, 20 or 100 times that amount. These printouts are often just a way for a lazy uninformed doctor to SOUND like he knows what he is talking about. “Aha your SGPT is eblevated” but then pin him down on what that means and you get a lot of hemming and hawing. What slightly elevated liver numbers usually means is that you are in the top or bottom 10% or some other arbitrary figure.
I LOVE avocados and would eat one a day but for the high cost. My fave USED to be the big shiny California avocados but lately they are NEVER ripe and taste like a hard green banana…no matter how long I keep them they just seem to go from unripe to rotten. I guess Burpee has found a way to give them an almost infintie shelf life with the slight side effect of making them inedible. Burpee and MOnsanto have a way with fruit…after all, turning the tomato to cotton, and making nectarines that NEVER softened, and plums that most resemble billiard balls were no easy feats.
The small HAAS avocados (black and nubbly) are much more dependable but don't have much fruit to them so the price per mouthful is very high if they are over a buck a piece. But I'll buy them when on sale a couple times a year. I whack them in half to remove the seed and put a Tbsp of vinaigrette, or bleu cheeese dressing into each half. A perfect avocado is like a taste of Heaven, but like Heaven, just as elusive.
Chou Yang,
SInce your weight and height calculate to a BMI of 41.6 place you in the class 3 category of obesity commonly called morbid obesity or super obesity, it must be dealt with. One of the direct conditions of weight that high is gout.
The best cure for super obesity is a regimented diet under the care of specialists in the field. Something like a 2,000 calorie diet with exercise to the point that your gout will allow is necessary. Alas a 2,000 calorie diet does not leave any room for more than a single drink or two (a beer is about 160 calories and a martini is 250.) But I guarantee, if you can maintain 2000 calories, counting every one, you will drop 2 pounds a week…and that's 30 pounds by New Year's day.
Beware though, that rapid weight loss, and that's what you need will result in more gout attacks. There are meds that can and will stop these attacks during your weight loss if they are given in large enough doses to keep your blood serum uric acid below 4.0 mg./dL or even 3.0, tested on a monthly basis. I am thinking a combination of allopurinol and probenecid….maybe 300 mg. and 1000 mg. respectively, but there are other choices.
What you have going for you is your age and the fact that you realize your dire situation. You also know that depression, while completely natural, will not help you.
You have 2 situations that MUST be handled together, you cannot deal with just the weight or just the gout… and perhaps a third, the heavy driniking. Do you want to elaborate on how much you drink on a daily average?
Have you ever watched THE WORLD'S BIGGEST LOSER on TV? I find it inspirational (don't laugh!)
I hate the two words “bariatric siurgery” and would NEVER have it done for myself or anyone I loved, but I do know a woman who had it done less thhan 2 years ago and has gone from >400 pounds to 121 (she claims, I think she weight much less today.) If she doesn't stop losing I fear she she will soon be dead but she claims to feel well and thus I keep my mouth shut. But I am sure someone will bring it up. I advise against it becasue you are too young and have other options open to you.
Please tell me you don't smoke.
ZIED,
Dietary treatment of gout is very rarely effective. Before the discovery of allopurinol, people with gout suffered a great deal and died earlier than they needed to usually from destroyed kidneys.
Lots of nostrums, mostly useless, were touted as being helpful and cherries were among them. Before 1950 there was nothing except colchicine and 16 or more aspirin a day available to treat gout pain. Neither of these EFFECTIVE treatments could be used indefinitely.
So yes, cherry jam is as useful as the juice. Jam is as DELICIOUS as the juice but neither is the proper or effective way to treat gout. As chance would have iit, this morning my toast will be spread with HERO BLACK CHERRY PRESERVES…yummy as all get out!
PERHAPS the most effective dietary regimen is no meat, no legumes, and all protein only from dairy, but this is not for mere mortals or people who want any enjoyment from life.
(I have often wonder what the “cherry cure” stories have done for cherry sales???
)If I recall correctly I listed allopurionol, febuxostat, probenecid, sulfinpyrazone, and benzbromarone in that order? Benzbromarone, though a good drug was listed last because it is not allowed to be sold in the U.S. Allopurinol and febuxostat are losted first and second becasue of the relative lack of side effects, expecially kidney stones.
Of the two uricosurics, I put probenecid first because it seems to be more often prescribed but since both have side effects:
Common side effects include nausea, skin rash, stomach upset, or headaches.
While the skin rash sometimes can be serious, other side effects usually are not serious and may go away as your body gets used to the medicine. If any side effects continue to bother you, contact your doctor.
It would seem the choice should be made (price being equal) based on how your stomach and head handle the drugs. I think sulfinpyrazone has the reputation of being harder on the stomach. Of course, you know excess water is advisable to avoid kidney stones precipitating from your urate rich urine.
How it works? The kidney is extremely compicated involving millions of bloodstream loops in each kidney that pass out almost all chemicals in the descending loop and resorb most in the ascending loop of each single nephron. The chemistry and competition of all this is staggeringly complicated. Best I can say is that I think both sulfinpyrazone and probenecid compete with uric acid in the reabsorption phase and thus more urate is dumped in the urine. Try to keep an alkaline urine while using uricosurics. I guess some litmus paper might be good enough (not sure how accurate in a very narrow range but I know it's cheap.)
Here's a decent comparison of the two:
http://books.google.com/books?…..mp;f=false
If that doesn't take you directly to the page, it's page 600 item 10…should be easy to select. The whole page is a good read.
I occasionally have it very clear in my miind but it comes and goes…I'll give it a first stab, and I say FIRST becasuse I have had several beers today.
A couple factors come into play;
Hypoxanthine is a chemical precursor to xanthine, the most common purine. Allopurinol is identical to hyproxanthine but for the placement of one atom. All these are acted upon by xanthine oxidase and a load of the fake hypoxanthine, allopurinol, stops the oxidation of the REAL hypoxanthine to xanthine and xanthine to uric acid. All are dumped by the kidneys but the kidneys much more readily dump xanthine and hypoxanthine than uric acid which is reabsorbed. On top of that allopurinol gets oxidized by xanthine oxidase to basically alloxanthine (aka oxypurinol) and AGAIN uses up more xanthine oxidase.
The second effect is that when xanthine and hypoxanthine are alllowed to build up the body uses the excess to more readily build nucleic acid from them thus in effect recycling them.
So more xanthine and hypoxanthine>>>more excretion and more reutilization.
That's why allopurinol is just so devilishly clever. It fakes out the body's bolluxed up inclination to turn all these valuable chemicals into uric acid.
I will look this over tomorrow and if I need to “refresh it” in the light of total sobriety, I will.
Make that “prophylaxis”..I hit the “g” instead of the “h.” That's what comes from learning to type after 50!
I've had a few goofy eye problems. One was sort of a dark ark that appears for a moment in the lower outer field of vision and then when my eye datrs towards it, poof, gone. Then a couple weeks later it pops up again. First time it happened I was frightened for a detaching retina but now I just dismiss it.
Another probelm I get that goes back a bit further is an arc of multicoloring “arrows” sort of like a good Van Gogh. This I KNOW is an “aura” prelude to a migraine so I pop a propranolol and hit the bef for a half hour…AWAY from the computer.
limpy,
That's quite a pile:
Terazosin 5mgs, Allop 200mgs, Bystolic 5mgs, Fosinopil20mgs, Lansoprazole 15mgs, Aspirin81mgs and i just stopped with Nystatin & Triamcinolone Acetonide
I'd rule out the allopurinol, nystatin, aspirin, and triamcinolone and check the common side effects of the other 4.
Of drug causes for eyelid myoclnia. the two listed seem both to be IODIDES…bizarre! Stress is also a common cause (like holding a full house with a big pot…”Oh PLEASE don't make my eyelid twitch!”
Is it a little more than that? Like a facial tic? These kinds of things usually go away as weirdly as they came on. If I get a rare twitchy eye, I can usually find a spot outside the eye atop the cheek and a little massaging makes it stop.
Jon,
What else are you taking…this doesn not sound like anything I've ever heard of caused by allopurinol.
The way I like to use colchicine is in doses of 2 or 4 for one day only in the rare event that I get a minor flare. For a major attack I recommend much more for a day.
I am not fond of daily extremey low dose propgylaxis.
Aspirin? Yep low dose asipirin (under 6 a day!!!!!!!!!!!!) retains uric acid. (Super high dosing dumps it like crazy.) BUT for those on a single pill a day to prevent heart attacks (whether 80, 160, or 325 mg.) the effect on gout is slight BUT the 30% decrease in heart attacks makes it a MUST for men over 40. Remember, a heart attack kills HALF of us…so avoiding that scourge is of PRIME importance. I take either 325mg. or 650mg depending on the position of Venus in the sky (or is it sunspots
) because I have heart disease. I assume my allopurinol covers the issue for me.But allopurinol or no, heart disease or no, I would continue my daily aspirin come Hell or high water
Don't know how I missed seeing this post.
But YES, HCTZ, and its sister thiazide diuretics is a cause, if not THE major cause of gout. I am 100% certain that it caused my gout (a decade or more at 50 mg. per day. The drug should be banned for men.
(From the noticed diuretic effect of beta-blockockers, I'm sure they contribute as well so the duo (like the origingal poster) was taking is a recipe for gout.) In that respect gout can be looked at as largely CAUSED by the entryl-level medical profession, GP's) who prescribe blood pressure medication by rote becasue they are not equipped to do much of anything.
Modestly high blood pressure MAY be a bit of a slight scourge, the proof is light, but after years of experience, I am reasonably certain that TREATING it is a FAR worse scourge. Absent my years of I would not have gout but alas, once you get got you GOT gout…forever.hydrochlorothiazide
Of course, anyone with gout really must get off thiazides…even the boobs with the stethescopes around their necks must agree on this.
