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Absent gout I would say Plantar Fasciitis, but in the presence of gout confirmed by an ankle aspiration in the last year, I would lean heavily towards a gout diagnosis.
There is no reason for gout not to result in an inflamed plantar fascia due to deposits of uric aciid, so an absolute call might be hard to make.
I would up my allopurinol to 300 mg. and double my colchicine.
sabre,
The BIG question is, do you have gout?
That depends on symptoms and serum uric acid. Can you get the exact number from your doctor? It is not usual to start medication with the first attack for the single reason that you don't have enough evidence and you cannot start a lifetime of medication on a HUNCH.
Yes, it is seeming more and more common for people to report their first attack after a large weight loss.
Stop the allopurinol since I doubt that you are ready to commit to it for a lifetime and just wait and see what develops. When you are CONVINCED you have gout, then it is time to get on allopurinol FOREVER.
Am looking for gout sufferer who has GFR of 59, is a woman, 62 and takes Micardis 80 mg, Lasix 20 mg and Colbenemid.
I think there might be ONE such person in Wichita, Kansas, but she doesn't have the internet.
For what it's worth, I take 40 mg. Lasix and 50 mg. Cozaar.
Gary,
Yes, the new pains are caussed by migration of urate/uric acid to new sites. This will diminish with time as the easiest to dissove deposits will be gone and those hidden away will mostly stay hiddden.
I think your plan to go to 400 mg. allopurinol is a good one, the lower your SUA the less likely the redissoving crystals will find a happy home. In fact 400 mg. is where I started for the first year or so and then settled on 300.
One cannot easily get between someone and his death wish.
Can you persuade him to see a doctor ONCE and get an RX for a years' worth of either allopurinol and/or probenecid.
(Sometimes chronic tophaceous gout needs both.)
Tell him, that while his joint damage is readily apparent, the destruction of his kidneys won't be obvious til he's near death.
Does he have a clue how dangerous his behavior is?
Failing EVERYTHING, one can get allopurinol on-line rather easily although the inflate the price A LOT. This is NOT the way to go but if it is the only thing that will prevent his slow suicide, then it IS an alternative.
The alternative is to whack him with a frying pan and call for an ambulance…tell them you were sloppy flipping an omelet.
“White Coat Syndrome “usually refers to blood pressure that is fine at home but soars in the presence of medical personnel.
caveman,
I doubt that it will make much difference whether you take them or not. You are in a state of watchful waiting to see if you have attack #2. You will or you won't. If you do you should get on allopurinol, if you don't have another attack consider that you probably don't have gout. Even if cherry juice concentrate will keep you free of attacks, who can afford to take ot every day, forever?
Or are you certain you will go on allopurinol in 6 weeks (from your earlier post) and are just trying to get from here to there without pain? If your doctor is really CERTAIN you have gout, then waiting 6 weeks seems a long tine to put you at risk.
I think maybe the best thing to do from now until allopurinol is NOTHING, behave normally. That way, if you don't have another attack you probably do not have gout. If you are taking a gajilliion home remedies, you might assume that you DO have gout but one of the remedies is curing you. Why throw too many variables into the mix.
Don't start taking allopurinol after just one attack. Since it's a lifetime drug you want to avoid even the SLIGHTEST possibility that you do not have gout. Taking a drug forever that is not needed seems awful beyond belief.
Although that 428 reading (British units…comparable to a 7.2 American) is not HIGH-high, it is still high enough to precipitate uric acid.
It is also low enough that perhaps you can control with low purine diet and fasting from beer.
So, stay in the state of watchfulness and have another uric acid test for confirmation and wait. You'll either have another attack or you won't.
The allopurinol is there if and when you need it.
Utube,
Yes, there is very little in life more terrifying than severe pain in the chest. No matter the cause it starts the adrenaline pumping and the heart racing while sweating with pure blazing fear.
Here's a good test to differentiate. Costochondritis (rib, cartilege, tendon, or nerve inflammation that cuses severe chest pain) is ALWAYS sensitive to body position and body motion, deep breathing, etc. Heart pain is NOT sensitive to body position or motion.
So if you sit still without breathing and there is no pain, take some ALEVE…but if it still hurts when you stay still, get to the E/R ASAP.
Also ALEVE helps costochondritis…it does nothing for heart pain.
Let me just add (sorry if repetitious) that after 9 days of the most debilitating pain I have ever experienced my dosage of colchicine had me walking the next day as if I had never had a gout attack at all. No pain at all.
(Lourdes, eat your HEART out.)
I am loathe to recommend high dose colchicine becasue I don't want to kill anyone. But the effects can be truly miraculous.
I guess the level of pain has something to say about what we will try.
I wonder how may people, if any, have ever diesd from a colchicine overdose?
I LOVE the quote at the end:
Old Dosing Recommendations for Colchicine: Take two 0.6mg tablets when you first feel gout pain. Follow with one tablet hourly until you get relief or diarrhea. Dosing until diarrhea occurred probably inspired the old quip, “People treated with colchicine often run before they can walk.”
Caveman,
Mine are close to the size of a pinhead…dosage 1/2 mg. I guess it there were no additives, the active dose could be in a pill the size of a pin POINT.
As I have not suffered from the runs and my pain has only ben relieved by perhaps 50% after 11 tablets,
Tough to say becasue I have only ONCE taken a THERAPEUTIC dose for an acute attack and I toolk 22 pills before the co-occurrence of vicious diarrhea and pain relief. My GUESS is that the 11 you took were not enough. I know I cannot make too much from my ONE trial of this megadose…but the effect was truly startling.
The old remedy that I believe in, from the Physician's Dest Reference of 1976 is”
Two to start and one an hour until paiin relief, signiificant diarrhea, or 16 pills. By that standard you stopped a bit too soon.
Why did you stop?
ZIED,
The basic of the basics is that you need to take a drug, usually allopurinol, usually 300 mg. that will keep your FREQUENTLY MEASURED serum uric acid below 6.0 mg./dL, preferably lower to start.
That will eventually keep you from having attacks.
Once you start allopurinol DO NOT STOP.
Hi Jim,
So I'm guessing angina with nitroglycerine? Have you had any angiograms, angioplasties, stents?…Heart attacks.
I doubt that allopuinol or colchicine have much to do with it…althout I imagine it is possible for the cartileginous connections between ribs COULD be the site of a gout attack.
If I read you right, you have been on allopurinol about 2 weeks? What dosage? Have you had you serum uric acid checked?
OY, 60 miles on a motorbike…did your ass hurt?
Colchicine is a potent laxative. You might not notice one pill per day.
Two pills a day will keep you VERY regular, if slightly more so.
Therapeutic doses of 8, 12, or 16 pills in a single dose (or as I stupidly did…22) for a massive acute attack will cause horrific diarrhea that lasts a day. The diarrhea and the stoppage of pain often seem to go hand in hand…a seeming dependence?
As soon as the diarrhea started for me, nine days of excruciating pain instantly came to a halt.
So if you want to call it a side effect, yes, probably 100% of colchicine users will experience it. I prefer to think of it as an EFFECT.
My theory is that colchicine causes an IMMENSE loss of body fluids and thus reduces the edema in a painful swelling and that is part of the cure (Be curious to try a whole bar of Ex-Lax and see if it has the same effect.). Accepted theory is that colchine alkalyzes an acidic joint, stopping the laying down of more uric acid, thus stopping the attack.
What is most important is that, whatever the methodology, IT WORKS.
Peter,
THe usual but rather rare reason for stopping allopurinol is RASH rather than dry skin. I had a few red dry “crumbly” patches in my hairline (of course the scare is always skin cancer…
) but I was able to get rid of them with daily applications of a cold cream type oily moisturizer every day and a hat in the Sun but it took MONTHS to get rid of them…to great relief.As for mild attacks or “twinges” after 6 months of allopurinol, I think that might be rather run-of-the-mill. I'd expect they will get more and more infrequent.
But I get occasional 1/2 hour twinges after nearly 20 years on allopurinol, especially after a couple dozen daily 6 packs, and thats fine. Perhaps had I never had a few crippling attacks and one killer, I wouldn't even notice the twinges now.
And talking to people WITHOUT gout, they get twinges too…so who is to say what twinge is gout and wat is a day-to-day mini/micro injury?
odo,
Thanks Zip, but how do we know it is only new deposits of urate which cause serious flares; I thought old deposits do as well, as they become exposed prior to disolving back into the blood? (I'm assuming that urate becomes uric acid again in the soluble state?)
What I said was that new PRECIPITATION causes the immune system to go bananas. Old urate causes chronic pain but it is the urate that converts back to uric acid and makes its way anywhere near the bloodstream and reprecipitates new crystals that is a major acute attack of frank gout. Perhaps the new recrystallization is almost in the identical place. Thus both new (from diet and cell breakdown) and old uric acid (from urate deposits) can cause major attacks by laying down “NEW” uric acid. The body despises uric acid deposition, it seems more amenable to monosodium urate. I doubt the immune system is much concerned with settled old urate deposits unless they get acidified.
One can only conjecture here because the exquistely complicated dynamics at the interface between urate-uric acid-bloodstream-joint fluid-nerve cells cannot be precisely measured. All we have is a few ham-handed methods of lowering the blood's total load of uric acid which seems to be enough to GENERALLY prevent a life of pain and disability.
Surely there is no discernable local difference in SUA once it has rejoined the systemic flow?
Picture a pile of urate…virtually 100% concentration (like 100,000 mg./dL…for effect) Picture what happens when some dissolving in locallized acidic environment occurs. What can you see as the concentration of urate near this heap? Think of a pound of salt dropped into a bucket…wouldn't you eenvivion a HUGE gradient of salt concentration between the bottom of the bucket and the top? So yes, I can envision VERY high concentrations near the dissolving tophus. For myself I feel my twinges about 1/2 inch inwards of my bunion joint that got hammered so many years ago. Thus I envision HUGE localized differences in SUA in the vicinity of gouty joints, perhaps even leading to dissolving and recrystallizing in or near the same spot.
nokka,
I kind of feel 200mg isn't quite so bad as 300mg.
Or as GOOD. (I couldn't resist.)
Time will tell if it's the right dosage for you. I have no qualms on somebody settling on 200 mg. as a final dosage, I'd consider him lucky IF it prevented all further gout attacks. My problem is starting new patients on 100 mg. or 200 mg. I feel strongly that that is likely to result in MORE net pain.
I think the analogy with antibiotics is a good one: Would a good doctor prescribe 100 or 200 mg. tetracycline/day to treat an infection that most people find responds best to 500 mg? Would he hope it works and gradually move up to the proper doseage over several months while the patient continues suffering.
What would we call such a doctor?
Taking less than enough of a drug because it feels somehow “holier” has always struck me as kind of silly. Taking an effective dose or none at all seems wiser. I hope your dose turns out to be the effective dose nokka.
Are you saying that the crystallization on my toe will be there for life (if not somewhere else already) and no medicine or self help can irradicate it.
Yes, drugs can cause some dissolution and white blood cells can carry away some urate, but the immune system will try to “wall off” a portion of the urate and some is extremely likely to remain with you forever. Thus you will never be in the enviable pre-gout situation where the body can carry a super-saturated load of uric acid without precipitaiton. You have crystals which will act as seeds to cause precipitation the instant you go above the saturation concentration.
When you first notice your gout you probably already have multiple sites of mini-crystallization that may have caused small aches and pains but were dismissed.
I wouldn't be surprised if a lot of people walking around who never had a gout attack, if examined closely enough would show urate deposits.
odo,
Here's how I look at it. Allopurinol will cause less urate production and cause some of the old urate deposits to dissolve as serum uric acid drops. This newly dissolved uric acid will migrate throughout the body until it is slowly disposed of by the kidneys. During that time, depending on local conditions, it might find a locale that is hospitable to recrystallization…perhaps some cold acidic joint. The larger the dose of allopurinol the lower the circulating concentration of urate and the less likelihood of having areas that are receptive to locallized precipitation. As we know it is the NEW precipitation that causes the immune system to bo bananas and cause a raging attack. The old settled deposits are troublesome but not acute.
Thus a 4.0 serum uric acid probably has no areas of the body with locallized 7.0, but a 6.0 uric acid probably DOES.
So somebody with all of the easily soluble urate deposits long gone from years of treatment migh be able to lower his allopurinol but someone just starting with lots of freshly laid down miscible pools of urate would likely get into trouble with low dose allopurinol.
If I were a doctor, I would prescribe 300 mg. immediately and tell new patients to watch carefully for any signs of hypersensitivity…never 100 mg.
Think of a hornet's nest. To get rid of it would you douse the nest with as much poison as you can get in as quickly as possible or would you squirt in just a little…and RUN?
cavemean,
All the above advice is very good. Yes, your weight loss and exercise probably brought on the attack which may or may not have been your first. But once you have had a gout attack you CANNOT get ungouted and things that your body may have dismissed BEFORE that attak will not be dismissed now that you have a crystallization point for uric acid. Think back, have you had foot problems before?
Don't make yourself crazy with dietary changes until you get a firm confirmation, the only thing you can do during an attack is to mitigate pain. Your immune system will eventually take care of the immediate problem.
On the testing: when you go in tomorrow to get the uric acid reading, have another blood draw…labs make mistakes, and 2 readings are better than one. If you are still in pain tomorrow and gout looks likely from the blood test, ask your doctor to prescribe colchicinee for the pain.
parceiro said:
It didn't dawn on me until today that my probably first episode was in the beginning of April, I woke up and my knee hurt and buckled when I walked. I thought it was a torn meniscus since I do martial arts and a couple of years ago I damaged that knee pretty badly in softball while sliding (I was out!). MRI was clear, but my othropedic said it was probably inflamed cartilage since I was moving into a new place and was carrying heavy stuff up and down stairs for a couple of days. Easily could have been, since I know knees are complicated joints and I have previous injuries there. Just thought I'd mention it because I just remembered it! It wasn't unbearable pain or anything, just annoying.
1. Do you guys ever get over being hyper-aware/sensitive to little twinges and mysterious sensations. It's driving me nuts. As far as I know, I've always had little itches and twinges in my toes and now I'm just being over-sensitive.
2. What are the earliest symptoms you get of a flare up or attack? I was at festival last Friday and felt a very very slight tingling in my big toe and thought “Oh great, this is probably the beginning” but it went away. It's all quite confusing.
3. This thing is totally managable right? With the right combination of lifestyle and meds, I can eventually get back to a mostly normal life?
Thanks a lot guys, there has been a ton of great info on these forums.
Cheers,
Parceiro
Hi Parciero,
On the knee, that “buckling” is more indicative of cartigege wandering where it shouldn't. I have a piece in my right leg that, after 30 years still gets out of place if a sit in a jostling subway…it occasionally buckles up my knee (cannot get it completely straight) for anywhere from 20 minutes to an hour until I can walk it back into place. (I should have long ago cut it out but a frind of mine died having that done…and he was 29.)
#1. Yep, hypersentsitivity to twinges will scare you forever once you've had a couple major attacks.
#2. My easrliest problem is always that first footfall out of bed in the morning on my right bunion joint or the instep immediately behind. With allopurinol it usually walks off after a couple minutes.
#3. Gout is usually completely controllable with the meds. It is usually NOT controllable with “lifestyle changes.” With the proper meds you can eat or drink almost anything you want.
Wait until you and your doctor are completely sure it is gout before beginning meds even if it means another attack or two…although with an 11.4 uric acid gout is HIGHLY likely.
Yes, lose weight but do it slowly…rapid weight loss brings on attacks in those prone to them.
Daniel,
Welcome to the club nobody wants to join (I LOVE that phrase.)
Serious side effects of allopurinol are very rare …if you can take it for a week you can probably take it doe a decade. I'm on my second decade.
You have SERIOUS gout if you have already had several attacks AND you have a serum urate of 11.6…that's horrific. You will NOT be able to manage the condition without allopurinol or $$$Uloric$$$. (I don't mention uricosurics becasue your kidneys are excreting enough, you are just MAKING too much uric acid. Your kidneys sound fine.)
Forget about the “natural” “cures.” They are as effective in curing gout as they are for curing cancer.
You'll be tossing your money away. You are just a kid and you cannot afford to be laying down any more urate deposits at age 25…by the time you are 60 you'll look like Lot's wife (turned to a pillar of salt.)
Start right in with 300 mg. allopurinol…don't let your doctor talk you into 100 or 200 mg. doses because low doses are likely to cause more attacks than they prevent.
The number I find most telling is the TC/HDL ratio.
Fortunately Lipitor seeems to raise my HDL to something like 40 so not terrible and my toal cholesterol is now usually in the 120's with LDL's in the 60's or 70's.
So I am not unhappy and can stop drinking for long periods without troubling HDL's like before.
(I have a particularly irksomely high Lipoprotein A which along with my very low LDL before Lipitor that caused me to develop coronary artery disease. I am pretty sure it is better now than it was in 1992 when I started getting symptoms)
Dan,
I wish I had a $1000 bill for every time I tried to build tolerance for niacin. I even tried starting with 25 mg. While it SOUNDS good in theory it absolutely did NOT work in practice. My upper limits for tolerating niacin is 250 mg. slow release taken WITH food.
Dan,
Good Luck trying. I know some people CAN tolerate high doses and some people can even tolerate flushing. (I think “flushing” is a rotten word to describe the pins in the face, purple chest, swollen lips and eyelids of angioedema that I get from this crap.)
LDL's in the 20's or lower are dreadfully dangerous…so it is worth some degree of discomfort to raise them.
But be heartened, daily drinking is a PROVEN and a confortable way to raise HDL's quit a lot. So if you fail at the Niaspan, there's always the Martini or a nice bottle of Bordeaux.
Teetotalling I get HDL's in the upper 20's…with booze I get in the 40's.
Jeff,
The 40 pound drop was extraordinary but the regular 20 pound swings seeem quite frequent.
No, he's not a roid-head nor does he have a bodybuilder's body type but he looks the PERFECT triathlete…most of the time.
I'm gonna talk to him about it next time I catch him between clients…I could use some weight-loss tips.
Jeff,
I don't know, Jeff.
But it seems that he is down to what looks like 5% bodyfat now. I saw him clothed and my first thought was anorexia, bulemia, or cancer but then I saw him nude and I realized that he is down to steel fibered muscles and sinews.
He had gained an exorbitant amount of weight last year…maybe 30 pounds and might just be overcompensating ala Scarlett O'Hara: “I'll never be poor again” = “I'll never be overweight again.”
From peak weight last Fall to today, I'll bet he is down 40 pounds…I've never seen anything like it short of THE BIGGEST LOSER, but this guy, at his WORST had a terrific body.
But then I guess it's easier to grind a bike up a steep hill at 40 pounds less.
(Who knows, maybe one day I'll go to the gym and see him hobbling around with gout.
I'll trade him allopurinol for steroids!)Well Henry got his comeuppance…after 4 years they killed him off on SHOWTIME this week (THE TUDORS.) The last year they had him walking painfully with a cane and wincing with each footfall while trying to look regal for his subjects…a hard act to pull off with gout.
Only problem with the series is the disrepancy between Henry VIII's actual looks and the incredibly handsome Jonathan Rhys Myers.
(Perhaps gout becomes inevitable after the third wife?)
So VG, next time someone doesn't properly respect your gout just bellow in your deepest voice:
“Take care with that tongue, sir, lest you lose the head that it sits in!”
“Fizzy” might be correlated with gout attacks because the fizz is dissolved carbon dioxide, aka carbonic acid, which will acidify your urine and maybe even your joints. But there is also good evidence that your body (rather than your urine) keeps itself within a narrow pH.
I have HUGE respect for triathletes and marathoners one of the trainers at my gym is a top level triathlete and his workout schedule AMAZES me. His ability to gain and lose 20 pounds in the blink of an eye is magical.
I use Hammer products because they don’t contain simple sugars. All of their goodies are maltodextren based and it provides a longer and flatter energy curve than tradition sugar-based drinks and supplements.
Don't get too blown away by nutrition company claims. For one thing, SUCROSE, the granulated stuff in the sugar bowl is a COMPLEX DOUBLE SUGAR, not a simple sugar like glucose or fructose. And maltodextrin may SOUND snazzy but it is merely a variant on solid corn syrup, and not much unlike HFCS, all cornstarch that is chemically converted to sugar. In fact:
from wikik: Maltodextrin is easily digestible, being absorbed as rapidly as glucose, and might either be moderately sweet or might have hardly any flavor at all.
If you want a SLOWLY absorbed sugar, choose lactose, not glucose, sucrose, or maltodextrin. In fact even fructose is probably absorbed much more slowly than maltodextrin. Better yet, use a complex starch. (There was logic behind spaghetti loading the night before a marathon.)
