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A long time friend and gout sufferer called me and told me the only thing that worked for him in his 15 years was Colchicine. So I got that prescribed a couple days later.
You are lucky to have such an astute friend. If colchicine works when other NSAIDS don't, it's gout. Alas if doctors cannot see it on an X-ray, often it doesn't exist to them. Even the worst cases of gout look like blurs on an X-ray…early cases are completely invisible.
Dino,
Get a few uric acid readings and consider getting on daily allopurinol if your numbers are too high and/or you start getting more frequent attacks. With the first severe attack only a month ago, perhaps a wait and see attitude might be wise. A lifetime of allopurinol shouldn't be rushed into without certainty of both diagnosis and degree of involvement.
My situation was similar in that a look back at my foot pain of a couple years made any sense only AFTER I had the attack from Hell that was both unmistakenly gout AND among the most God-awful pain imagineable. Then it all fell into place and I started allopurinol.
p.s. You must have a cast iron stomach if you can tolerate 800 mg. ibuprofen 3 times a day. I am gettin gastritis just TYPING this.
The food lists were designed, poorly I might add, for a time when there were no drugs to control gout except colchicine to stop pain.
Probably the ONLY decent dietary advice is to completely give up meat and fish but that is heretical in any country where meat production is a major industry, so the lists are congloms of half truths and twaddle that really don't do anything to help people with gout.
They are anachronisms just like bloodletting to cure infectious diseases (before penicillin) and prayer and enemas to cure cancer (before surgery,) and chicken soup for influenza and pneumonia.
A doctor on another board said that in cases of incurable disease doctors must still DO SOMETHING. My feeling is just the opposite (that topic was about useless treatments for influenza.) I guess our major difference was that HE got to bill for doing nothing…patients get to PAY for it.
Mankind HATES to be helpless so we invent nonsense to SEEM like we are doing something. Alas, too often the nonsense lasts LONG after the cure. And in the really sad cases the nonsense takes the place of things that actually WORK.
And I guess now, in the age of the Internet, the OLD useless nostrums will be bandied about AND SOLD until the end of time.
For those that doubt me, do an intensive study on the web and see if you can find a SINGLE disease for which treatment with an alkalyzing or acidifying diet isn't given as the cure.
Might as well go back to the 4 HUMOURS or the PHLOGISTEN theory…or check your CHAKRAS, your CHI, or sacrifice a virgin to BAAL.
There are excellent and cheap drugs that treat gout very effectively. There are also a myriad of ancient and useless “cures” touted on the web.
So we all make the choice when our foot begins to ache or crucify every couple months or weeks.
Eat a dollar's worth of cherries every day and give up sweeetbreads (dumbest recommendation in history) , or pop a pill for a dime.
And alas, of course any uricosuric will eliminate uric acid in all its forms. Too bad for us that allopurionol and it's most active metabolite, oxypurinol, are almost identical to uric acid…that's why they work.
So out goes the baby with the bathwater…AGAIN!
Why is nothing EASY!
But then for those NOT on allopurinol, the uricosurics are a good idea.
(And you DID remiind me to boil up a pound of dried figs I've had since the FLOOD, and they are always DELICIOUS….with a good squirt of lemon in the boilwater.)
Jess,
I'm pushing 2 decades of daily allpurinol use. I've never experienced dizziness.
The only bouts of dizziness I've ever had that were gout related was early on trying to treat acute attacks with Indocin (indomethacin)… that drug had me constantly very dizzy.
Yep,
that's very interesting.
With that pH swing of 6.5 to 8.9 I doubt that it has to be any larger…that range is a hydrogen ion content of several hundredfold.
I've mentioned it occasionally but with little emphasis as in “who knows what the temperature and pH of the affected joints are.”
Hmm,
Uric acid solubility with pH? Let's see what I can dig up without running into $$$$$Springer links$$$.
One of the problems seems to be the relationship between uric acid and monosodium urate…both of which present gout problems and each has it's own relationship to pH.
Then there is the other quirk of uric acid solutions:
As much as 220 mg./dl. of uric acid could be dissolved for 24 hours at pH 7.0. But following seven-day incubation the total dissolved urate concentration decreased to 16 mg./dl. due to NaU crystallization. The stability of NaU supersaturation depended not only on the concentration of sodium and urate anion but also on time and pH.
There is this strange TIME relationship. Might explain a bit why a high concentration or urate after exercise doesn't cause pain til the next morning.
Let me add another bugaboo to your good questions:
Is there anything we can do with diet to change the pH of our synovial fluid?
As an overview to this question, perhaps gout is a disease ultimately caused by too acidic a synovial fluid. As as adjunct, long ago I read a good long article (on paper actually) about how colchicine worked and why it was so specific to gout. THe writer said with some certainty that colchicine alkalyzed the synovial fluid. Sounds logical to me.
And appropos of nothing: I found that the SKIN is a rather acidic 5.5.
Very few people can control their uric acid and thus their gout with diet.
Back before the drugs, gout was often a slow death sentence.
I wonder if anyone has ever compiled a list of uricosuric foods…there MUST be some?????????
Believe me, after a point, being called too young for ANYTHING is to be taken with untrammeled GLEE!
Pssst, just between us…if you are on alllopurinol you can sneak in several pints a week. That's why we love it.
Allopurinol is a pretty innocuous drug. And there are three or four alternatives…buit probably none more risk free.
BUT and this is a BIG BUT…it is very likely you do not have gout. For a 21 year old women the chanaces arre miniscule. Before you get on a life of drugs make TRIPLY sure of that diagnosis.
Can you share wit us the results of those 7 blood tests and was it a good rheumatologist who made the call. What kind of symptoms have you had? Have any drugs made a difference, like colchicine or prednisone?
I DO understand the exigencies of supporting a website Keith.
To have a beautiful wetland, I guess there must be mosquitoes.
I probably should have written to you privately.
From your picture you seem to be a pretty big guy, and thus you might have more cells than most processing more purines than most. So maybe something more than 300 mg/day allopurinol, the dose for the average Joe, is a little too little for you.
Seems logical that bigger people might need bigger doses.
Neither stevia, aspartame, sucralose or even sugar has any effect on gout…or at least none that is currently known.
But indirectly, anything that helps prevent us getting overweight is a benefit.
Perhaps the 600>>>300 was too abrupt a change. It sounds like you might be happiest with something in between. But let a couple of uric acid readings determine it for you.
Are you sure those Alaska Sorrels arren't allowing your tootsies to become a little cooler than you think? The solubility curve of uric acid falls off dramatically as the temperature of the joint drops.
Sorry to hear that you had an attack in spite of 300 mg. allopurinol.
He is the expert and it sounds reasonable to me.
BUT, achieving a 3.0 is not easy without also adding a uricosuric, if even THEN, which in your case is probably contraindicated.
Problem is that the lower the SUA the lower the excretion rate of urate…so lowering SUA is sort of self limiting.
david,
I don't have one and I would base my recommendation on whether or not you are medicating your gout. If taking allopurinol or Uloric I would say don't waste your money.
But if you are trying to control your gout with diet than I think a tester is a good idea.
Ah but Hans,
There is that little wrinkle called a fatal heart attack to consider.
From most of what I read the consensus is that the TEEENY doses of aspirin that are enough, or ALMOST enough, to prevent platelet clumping and clot formation on our coronary and brain arteries won't retain much urate. But then I've read that the smaller the dose the more the effect on urate retention. (I know, I know, who to believe!)
So it seems one might have little to fear from 80 mg. aspirin/day.
But then I have also read that a third of people are NOT protected against platelet clumping with only 80 mg. aspirin.
For me, with proven plaque deposits in a couple arteries and a stent in my right coronary artery, I take 650 mg. aspirin/day and I assume the allopurinol will sort it all out. I'd rather risk a sore foot than a casket. So far so good avoiding both.
(So I like my booze including regular overdoses of beer, I love my meat and fish, I take copious aspirin…any wonder why I think allopurinol is a wonder drug given to man directly from the hand of Zeus?
)High uric acid CAN cause itching directly but it is not likely. BUT indirectly, high uric acid can damage the kidneys and underperforming kidneys can READILY cause itching.
earthmusck,
Next doctor visit, when you get your uric acid measured have doc run a liver panel. THe buildup of bilirubin is ALWAYS associated with extreme itching and it is the first marker for liver damage…usually caused by hepatitis. Best to rule out liver problems whenever you suffer long term itching. Is there any yellowing of your skin or eyes?
Yep,
Stay away from aspirin with gout unless you can commit to taking about 16 a day…a real stomach punch.
Low doses of aspirin retain uric acid, huge doses dump it readily.
I'm not a meter kind of guy, turkey…unless the tester equipment comes down in price A LOT. But others here have a lot of experience with them.
hans,
I'll get you started…it seems to have changed since last I looked, so fiddle with the green tree icon on the post reply.
It HAD been easy to upload from our computers but now it seems to want an internet link so it might require first uploading your image to something like photobucket.com to get a URL??????
When I hit the BROWSE, all I get are GP's choices, rather than my computer structure where I can find my own pics.????????????????
We need to wait for GP's help here…I think he changed something.
turkey,
That 3-4 weeks ago should be good enough for a baseliine SUA. Start taking the allopurinol and get another blood test a month later to see if your numbers are good.
If you have about 30 colchicine on hand (Rx needed, so call your doctor,) that will get you through any flare-ups…but many of us never had any downside to starting allopurinol.
For the first couple weeks try to go very light on fish, organ meats, and beer and drink plenty of water.
Leonard,
Good for you. I too had no further attacks nor a single side effect after going immediately on allopurinol. I went on 400 mg. and got a 4.7 lab test a month later .
After a year or two I went to 300 mg. and stayed below 6.0 for a decade.
Warning: then I went to 200 mg, thinking that lasix-losartan would keep my SUA low. I got a lab of 6.7 and too many joint twinges. Back to 300 mg. and all is well. So do not be too quick to snap that allopurinol in half. Almost nobody controls his gout with 150 mg. allopurinol.
Peter,
1. Allopurinol will NOT considerably reduce that tophus. It is pretty much isolated from any effects of the bloodstream.
2. Do NOT let Dr. Sawbones do what he recommended. He is suggesting a procedure that is purely cosmetic. If you have no pain or motion now, after the surgery you will still have no motion but are likely to have more pain.
3. See someone else who can remove much of the tophus less drastically. I'm sure there's SOMEONE who doesn't have to remove your toe. Sounds like someone going in for spinal surgery needing to have his LEGS removed first.
4. Now here's a zip cure…I'd do it to myself but I don't know if I would recommend it to someone else: Perfoprate the tophus and see if it will drain. Given half the chance the body will rid itself of toxins. I drained a tophus the size of a small white bean or a large pea from my first thumb joint. Scary but a complete success.
Peter, can you post a picture of the ugly bugger? (The toe, not the doctor!)
Mid forties for me with mysterious pains in feet that would last 3 days but have me on a crutch. By late 40's it was confirmed as gout.
Charles, what kind of uric acid levels do you run?
I agree completely.
If you have any problems with side effects or lack of efficacy with allopurinol, not likely, you can always switch to the new and much more expensive Uloric.
Yes, it is long past time that you should be medicating your gout. Thirty attacks is at least 20 too many because each one does lasting and cumulative damage.
rdavisii,
Heavy muscle breakdown most definitely releases copious quantities of nucleic acid and the normal route for these nucleic acids is conversion to uric acid as an endpoint. Allopurinol blocks much of the final conversion and thus prevents too high a serum urate level…but the serum urate can still overwhelm the drug
Hiking, being more modestly aerobic shouldn't have so much of an effect on muscle breakdown (unless you try to climb the wall of the Grand Canyon.
) More breakdown would be expected from heavy werightlifting or “to the wall” aerobic-anaerobic workouts like a marathon at a good time.So, your chances of an attack during the trip will certainly be greater than watching the Olympics but the allopurinol will probably keep your uric acid down…that's what it's made for.
Have fun! (I haven't been to the Grand Canyon in 40 years.)
Gee, I posted to this yesterday…and nothing?????????
Well, here goes again. Sulfinpyrazone is a good drug but not frequently used. Why did your doctor choose it? It is for people who have demonstrably low urate exceretion based on a 24 hour urine gathering.
If you take it with kidney disease make sure you drink copious amounts of water and keep your urine alkaline so the urate doesn't form kidney stones.
If your doctor has NOT performed the 24 hour urine test, ask him why he hasn't chosen to treat you with allopurinol instead…easier on the kidneys becasue it causes less uric acid to be formed.
With a 9.7 to show a doctor, either or a rheumatologist or a GP should be able to see the wisdom of an immediate Rx for 300 mg. allopurinol. Another blood uric acid draw for confirmation is a good idea before you begin the allopurinol because then you will have a good baseline measurement.
There is little room for doubt with foot pain accompanied by an SUA of 9.7.
Like you, my first attacks were 3 day atttaks in my ankle and instep so gout wasn't clear until the Toe from Hell about a year later. My moronic GP claimed a 9.0 uric acid was NORMAL…yep, and he kept his license until he retired to great wealth.
turkeyspurs,
Replace the beer with martinis, Manhattans, scotch, gin and tonic etc.
