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matty,
Don't drink alcohol with that analgesic combo. Alcohol increases the risk of liver damage.
If you are not getting pain relief, call your doctor and ask him to call in a prescriprtion for colchicine. After all, it's a long time til the New Year.
Stinging nettle and celery capsules are very likely totally useless.
Don't wait too long to get the bugger out; a septicemic infection from a bad tooth can be horrific, even fatal.
There are a lot of dentists who will not do anything to an aching tooth that might have infectedd down into the gum (abcess) until the infection is cleared for fear of spreading a septicemic blood infection.
This goes double for anyone with a heart condition or any kind of vascular implants upon which a bacterial colony might establish itself resulting in endocarditis or periocarditis.
In most cases the antibiotic is overkill but it's protection against the rare cases that can be fatal.
utube,
The Z-pack and allopurinol should be fine to get you through your dental work.
(I LOVE Z-packs…for me they have INSTANTLY cured a couple cases of bronchial pneumonia.)
µmol/L = mewmol per litre
That would properly be pronounced MICR0 MOLE per liter (and is 1/1000 the concentration of a MILLIMOLE (mmol) per liter
Start with allopurinol 300 mg./day and plan on being on it for the rest of your life. THere is no need to do a trial at a lower dose because you have already used it and found no hypersensitivity. Allopurinol does NOT cause extra trips to the washroom.
There really are no other choices since you have already determined that the best you can do with dietary restrictions is to lower your SUA from 11.5 to 9.5 and that is not even CLOSE to being good enough…you need to be below 6.0 and after the years of attacks being a good DEAL below 6.0 is good treatment.
Homeopathy is quackery…some people get placebo relief for certain condition (the vapors? :D) but nothing more and there is no such thing as placebo relief from gout.
Is this reversible at her age?
I doubt it very much but as Gp said, there is little to be lost with a drug remiment that keeps her uric acid low; at least her pain should be diminished if no more urate is being added. Destroyed joints remain destroyed.
1. Almost always there are NO long term side effects. Rarely there is rash, and even more rarely sometimes that rash can point to a very serious condition. (10,000 hyperuricemic veterans were studied in Canada…some on allopurinol, some not. The allopurinol group lived longer.)
This answers your long term concerns but remember hypersensitivity to the first dose can be serious and life threatening with itching, hives swollen lips and throat and even asphyxiation. After a couple weeks this becomes a non-issue.
2. If AP has an effect it is to the skin.
3. Liver function tests are more necessary for febuxostat (Uloric) whose excretion is by liver breakdown…allopurinol il excreted through the kidneys (although the interaction with xanthine oxidase occusrs primarily in the liver.) Doe AP really harm the liver? NO!
4. Test serum uric acid regularly.
5. How long allopuyrinol takes to be really effective ddepends on dosage, serum uric acid levels achieved, and the amount of stored urate (tophi.) Your mileage may vary.
6. At first check SUA regualarly maybe every 2 months minimum. Once your SUA and your AP dosage is constant, every 6 months or year is sufficient. Make it part of your annual physical.
7. Hmmm, how can I get the alcoholic effect from my allopurinol. That would save me a LOT of money.
It is not likely you will be able to reduce your dosage to 100 mg./day.8. You're welcome!
Dr. Buff,
Re those horrific tophaceous pix on the web (and in medical books), no they will not resolve in a couple months…maybe a couple years. Big enough tophi that are mangling the function of a joint must/should/may be removed surgically.
At a SUA of 3.05 (talk about medical personnel not knowing what significant figures mean??? maybe it was 3.05127932? ROFL) I think you are doing as well as you can and should see significant tophi reduction without too much pain in several months. Keep measuring your uric acid, and to 1 decimal point is MORE than close enough.
Yes, that is as good as medical treatment gets so try to stay there. As GP says, EXCEPTIONAL.You will not remove all your tophi with meds nor can you restore any erosion that has occurred becasue your doctors were incapable of diagnosing the oldest disease in time…I'm sure they were busy measuring your blood pressure, which is what they do best.
Remember, we remove uric acid by a few hundred milligrams and tophi weigh in at ounces or 30 grams per ounce or 30,000 mg. per ounce. Add to the fact that the deposits are walled off by fattly deposits, pus and, scar tissue so drug treatment may not reach them. That's whay it's so important to prevent their formation. So the net is that some tophi you will have to live with unless you want to resort to surgery. Caution: I doubt that many surgeons are good at this anymore…too busy with brain and heart surgery that pays better.
(I am beginning to think that more of us should be on probenecid…but I have no experience with it.)
ps…If you are getting UA levles of 3 with probenecid, do not worry about under or over excretion becasue it is obviously the right drug for you.
Dr. Buff,
Azithromycin (Z-Pak) is a good drug for chlamydia, probably the antibiotic of choice, and it has very little effect on uric acid and will work well for chlamydia (and gonorrhea.) You can even take it in ONE BIG DOSE if you choose. But beforehand, it is best you get a culture done so you know exactly WHAT bug is causing your prostatitis becasue there are many causes and prescribing long term use of one antibiotic after another is not good treatment.
Alas, most doctors are too lazy to get a culture done…it is easier to scribble onto an Rx pad.
More importantly, how are you treating your gout? Do you know your serum uric acid levels?
Recommendation often include soaking your finger for a few seconds in hot water, and then drying carefully before pricking. Alternatively, swinging your test hand around in a large arc for a few seconds gets more blood into the finger.
Failing that, keep milking the hand to get a big enough drop. NEVER try two applications of blood.
After a while you'll know how big a drop is okay.
I think this discrepancy in the amount of blood delivered is the single cause of erroneous reading.
Now I know why Stephen Fry likes cricket:
The twenty-three year old Stuart Broad is certainly the best-looking cricketer we have ever produced. Melting looks, golden hair, eyes of the bluest blue, he is six foot six of heart-stopping youthful splendour.
The only adjectives missing were “throbbing” and “turgid.” ROFL
During college I spent a summer working in a brewery, hic. Is marmite REALLY the slop that we used to hose out of the vat after the beer was fermented. Eccch!
If so I would think it would be among the very WORST foods for gouties (yeast is all cells and thus lots of nucleic acids.)
BTW,
Cricket is a game with NO discernable rules…but at least it moves faster than American baseball which is worse than watching paint dry.
Do you start with two pills, then one an hour or just keep it to one?
Actually I DO take 2 colchicine as my first dose but since I KNOW that an acute attack that has gone on for a while will probably take at least 10 pills, I skipped that step in the interests of brevity, since I've mentioned the routine so often
. Once one has taken the whole shebang, up to 16, I don't think it matters much if one has doubled up the first hour or not.But yes, by the book calls for 2 pills to start and of course for a short flair perhaps requiring ONLY 2 or 4 pills total, it might yield quicker relief taking 2 to start.
Someone with a wide foot front needs a wide toe box. Few shoes are made that way, in fact one might think, just looking at most shoes
that most people have only one or two toes.
My toes are the widest part of my foot by a wide margin and next comes the dimension accross the bunion.Obviously given the need for a WIDER toe box the worst thing one could do is to add anything like an orthotic which makes the
whole works even tighter.
Barefoot is best but I guess most places frown on that at work unless one is a lifeguard…or a porn star.
I of course remain stridently attached to the old colchicine regimen:
One an hour until the pain is gone, you have reached 16 pills, or extreme diarrhea has begun.
Probably, one should not sleep for few hours after such high intake of purines.
That sounds like a logical corollary to me.
nokka,
Go to 300 mg. allopurinol. Don't linger at that 6-7 range or you're going to get into trouble with a big attack. Why stay at the borderline between effective and ineffective dosage?
I don't trust testers that depend on the size of a blood drop for accurate results, thus I have never sprung the couple hundred bucks to begin my own testing. I've seen too much variability in glucose testing with testrips (but the DID give me that tester for free!.
)Have a nice shrimp pad thai on me!
cjeezy said:
I guess for me the question is, how can I have twinges in the morning after a high purine meal or drinks when UA is below 6? Can high purine intake cause flare ups even if your below 6…or is this all in my head and its not possible lol
Perhaps there is a fleeting time, a half hour, 3 hours, a half day, some time after a high purine meal where the serum uric acid soars above 10 or 15 mg./dL. Perhaps one COULD catch this burst if one were diligenltly monitoring SUA eve half hour after a purine meal…an expensive proposition.
For example, a serving of sweetbreads, the worst offender admittedly, provides the amount of purines that the resulting uric acid would take 2 DAYS to clear the body! A meal of calves liver is nearly as bad. Thus there has to some point where all those purines in a couple hours after digestion would result in an IMMENSE flood of blood urate. Let's do the numbers on a gram of purine. Assume conversion on a gram to gram basis…this is close to exact becasue the entire xanthine family including uric acid differs in only a couple atoms from one another, the purine base is a constant.
So a gram, (1000 mg.) of xanthine dispersed into the blood is 1000 mg. into 50 dL of blood (the average human.) If digested and converted instantaneously the burst of uiric acid could be as much as an increase of 20 mg./dL in SUA…horrific.
So, given a need for 2 days to dispel this dose off urate and a digestive process measured in a few hours to a half day there MUST be a huge burp-up in SUA. Add to this the fact that the body is already at close to the balance point between input and excretion before the dietary insult and it is easy to imagine the effect being triggered by far less than the fabled sweetbread meal.
So, I guess I am saying that a person with USUAL SUA readings <6.0 may show MUCH higher fleeting bursts. It seems quite logical to me that this should be so.
Can I ween my self of the tablets say after 6 months to see if the levels return to a high level after weight and diet changes or will that be too much of a yo yo effect.
Short answer to that is an empatic NO, you cannot ween yourself off allopurinol!
If one's goal is the eventual drug-free treatment for gout it is best not to start allopurinol. If one is going to commit to allopurinol it should be a life's committment. Gout does not go away!
And an ACUTE ATTACK OF FRANK GOUT is akin to the blue screen of death that lasts over a week on the computer.
Or else knocking one's monitor off the desk.(When I mention I felt a twinge it is ALWAYS foot pain on arising from sleep. Day in and day out sore feet from being on them for a long walk in new shoes or 45 minutes on the elliptical <always barefoot> or pain from kicking my scale across the room with bare feet I ignore.
I really think it is difficult to lay down new urate when you are up and around, maybe too much blood and lymph flow? It is a sinister disease that attacks during the night when we lie motionless in the dark. Yep, a vampire's visit is a good analogy…or worse, a bedbug's.)
Up until last year it had been nearly a half century since the LAST development (allopurinol.) It was 58 years since probenecid was approved. So every half century or so is the best we can do.
Think of gout sufferers born in Medieval time who had to wait a millennium until the first drug.
Picture an area that is 100% urate…a tophus in your foot. With a low SUA there is still a war zone at the border with pure crystals mixed with old pus and partially walled off urate…PARTIALLY. Occasionally there's a break and more crystals are exposed and some dissolve but some are attacked by white blood cells and re-walled. This can go on for days, weeks or years depending onthe structure and amount of the crystallization and the level of SUA and the doggedness of the immune system. It can take a long time to resolve the war.
I recognize what you mean when you say foot twinges that last seconds or minutes…I frequently get the same. If they ever go on for a half hour, I'll reach for a couple colchicine but that happens only rarely…maybe once or twice a year.
usher,
This is the 3rd antibiotic in less that two months for my sinus infections. Bactrim was the first one- bad side effects.
That's pretty good evidence that your sinus problem is NOT bacterial.
Ouch,
That's the longest copy and paste I've ever seen. It makes the page take forever to load. Perhaps a link would suffice?
Gee I hope allopurinol usage doesn't lower out chances of success in worldly pursuits. 😀 😀 😀
cjeezy said:
My buddies mother (who doesn't know I have gout) sent me the following email yesterday:
“…come over for our annual Christmas Eve dinner. All seafood. Squid, haddock, smelts, shrimp, anchovie rolls,etc. Pasta and all kinds of desserts. Dec. 24th at our house!”
Thank goodness for AP! I'm there!
I hope you get to wash it all down with several pints of good strong ale: a Purine-Fest, all you are missing is Sweetbreads ala Francaise!
(Betcha you feel some toe twinges the next morning even WITH allopurinol!
)Sounds really delicious.
Seriously though, it is so good to hear that you both are doing so well on 300 mg. allopurinol, a real wonder drug.
Personally, I have gone on a high beer diet since Thankgiving (until New Years day when I always teetotal until April 1…Yuengling Black and Tan this months fave) and have decided to add another hundred mg. making my dose 400 mg./day this month. Lucky I have several bottlefuls of 100's still around.
After a few days of beer I can STILL detect that certain toe tingle and discretion IS the better part of valor.
Sesamoids are a pain in the ass becasue they are so small but so necessary. Hard to believe any bones so small as the toe sesamoilds can fracture, but they do. There is little they can do except put them in a long term cast (a pain) or remove the broken fragments which can destabilize the joint…not so bad if they leave ONE of the two. I guess all those martial arts kicks took their toll. Have they considered removing the one broken and/or dead sesamoid? Toe stability can be mainted with just the one remaining good sesamoid. Can they put a prosthesis in??? (Don't know if foot surgery has gone that far yet.)
Anyhoo,
I was put on 100mg Allopurinol for 34 months, increasing to 300mg until blood uric normal for 6 months reducing to 100mg for long term with aview to coming off and monitoring every 3-4 months.
That treatment plan was nightmarishly awful. Allopurinol is NOT for dosing until one can get a couple good SUA readings with an eye towards stopping. One commits to allopurinol for life; gout just doesn't go away, it is not like a bout with influenza, more like diabetes. Long term gout erodes the joint bones of the foot and perhaps this erosive process weakened your sesamoid and made fracture easy with one wrong kick
Gout seems to LOVE foot fractures and congregates right to them complicating healing.
BTW,
Podiatrist concerened at the clour of my injured foot , it looks purple and swollen compared to the good foot.
That's EXACTLY what a foot looks like in the midst of a gout attack.
I STRONGLY recommend you start taking 300 mg. allopurinol immediately if you are not already doing so. Don't bother with the 100 mg low dose nonsense because you already know you can tolerate the drug.
Drugs.com shows 6 major interactors with Augmentin but allopurinol is not among them, and 58 moderate interactors with the drug…no allopurinol.
They mention the SLIGHT INTERACTION with allopurinol, an increased risk of skin rash that GP has spelled out and they conclude:
There is probably no need to avoid concomitant use of these drugs in patients who otherwise can take these drugs individually.
Don't stop the allopurinol.
The combo drug augmentin is reserved for proven or highly suspected infection with susceptible bacteria…it should NOT be used for a case of sinusitis unless a sample was sent to the lab and grown to show the susceptible bacteria,
Sinusitis – caused by β-lactamase – producing strains of H. influenzae and M. catarrhalis.
for any other bacteria or ANY viral sinusitus it is useless…and worse, might help develop resistance to the drug in other bacteria floating around the body. I wonder why doctors are so averse to sending swab samples to the lab? But they are.
chaco,
In metric terms you want to be looking at a steady <.35 (which is equivalent to <6.0 mg/dL) rather than the top of the “normal” range. Once we have had a gout attack we are no longer normal. I think it is highly unlikely that good living can get you down far enough and I recommend a drug regimen…usually 300 mg. allopurinol.
Your .56 corresponds to the conventional 9.5 mg/dL and that is very high.
Mik,
Gosh, that doctor system in your area sounds so PRIMITIVE.
My feeling is strongly in favor of urate lowering drug treatment with allourinol if possible, or probenecid if necessary. Both can be gotten without insurance at any Target for $10 for a 3 month supply. Treatment requires blood tests to keep your uric acid below 6.0, thus both require a doctor. If you are both disabled is it to the point of being on Medicare or Medicaid…that makes regular blood tests easier.
To treat gout WITHOUT using drugs a REAL requirement will be ending the daily beer drinking. I almost NEVER have anything remotely like gout pain (long time on meds) but Thanksgiving and about 10 bottles of super-hoppy “boutioque” type beers are twinging my feet pretty good. First colchicine required in several months but 2 tabs, and no beer since T'giving, seemed to do the trick by this morning.
Seems they are using neurontin off label for EVERYTHING these days. Is it available generically (gabapentin) yet? It's been around for about 15 years
(I like your writing style…especially the “tryptophaned butt.”)
