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Indometthacin is a decent but not great drug for gout pain and 3 weeks is enough of a trial of it's effectiveness, or lack thereof.
Ask your doctor to call in an Rx for colchicine. It works quickly and is gout specific.
(I think 300 mg. allopurinol is a better place to start when the attack subsides and there is NEVER a need to take your allopurinol in 2 doses…once a day is perfectly fine.)
Your UA of 7.7 isn't too awful and you should get the attacks to stop pretty quickly once you get on allopurinol.
If you get your Rx for colchicine and you want info on how to take it, just post.
Wes,
So you DO have gout and my guess is still on target (Oy, I think the last person with a uriic acid that high was LOT'S WIFE!
)So now tell me how they diagnosed rheumatoid arthritis?
Justfoundout,
Your uric acid is extraordinarily high for a woman of 24. And primary gout is almost unheard of in your demographic. It's not JUST a disease of older men, many young men get it too, but it very much NOT a disease of young women or children.
For that last resaon get a second opinion before you begin treatment. Make sure a good doctor looks for conditions that might cause high uric acid as a secondary symptom.
Just a stab: have you gone on a crash diet and lost a lot of weight recently?
Most legumes have an array of low level poisons in them and man found out long ago that most if not all of these poisons are inactivated by long simmering at the boiling point. Perhaps peas are an exception. Even raw peanuts are extremely problemmatical.
And there's no mystery to it…just chew any raw bean and it TASTES poisonous…whether the taste is oxalate or Phytohaemagglutnin (kidney bean lectin) who knows, but the taste is as bad as tastes get.
So unlike fruits which evolved to be delicious and thus eaten and the seeds excreted far away, beans, BEING the seed have no wish to be eaten and evolution has preserved them with poisons (until man invented the saucepot.)
Thaijim,
Why not add losartan (Cozaar) 50 mg./day to your furosemide…it ameliorates the uric acid retaining properties of furosemide. A good blood pressure combo. Only problem is that in the U.S. it's still under patent and a bit pricey but I'll bet it's generic in Thailand. Furosemide ALONE can cause gout although not as readily as thiazide diuretics.
(Totally appropos of nothing: I have several gay friends who consider Thailand a MECCA for gay men..ROFL)
IF you choose to leave the liquid unrefrigerated for a day or two remember that you have sterilized it while boiling. If you put a cover on the liquid while hot, you will guarrantee that no mold spores, yeasts, or bacteria will alight on the surface when cooled.
So if covered when still very hot, it will stay fresh a LOT longer than if left open to the room.
Wes,
The SURE way to sort it out is to take a needle biopsy of a large tophus. Under a miicroscope and polarized light an proper staining urate shows up pretty clearly. If you have to push your rheumatologist to get the needle biopsy, then PUSH! Treatment of people with severely tophaceous gout is pretty extreme so you want to be ABSOLUTELY SURE of the diagnosis before you begin aggressive treatment.
Now the HARD part is the differential diagnosis of RA which is VERY dicey and requires a raft of tests for confirmation, just rheumatoid facot or a high ANA is NOT enough.
Occam's razor is often the answer…the simplest explanation is ususally the right one. If you have proven one of two similar conditions, the OTHER becomes extremely unlikely. For example a mangled corpse on a sidewalk MIGHT have been hit by a bus or he MIGHT have jumped from a high building…but VERY rarely did both occur.
So I am going to GUESS that you have gout and NOT RA. I hope my guess is right becasue gout is FAR more manageable than RA.
(Let me know if my guess was on target.)
Here's my vision on the CVD-hyperuricemia connection:
Just like deposition into ligaments , joints and kidneys, urate can crystallize onto and INTO an artery wall. THe body perceives the antigen and attacks with phagocytosis…the artery tries to protect itself from this inflammatory battle and end the attack by covering over the whole magilla it with a waxy fat hiigh in LDL choleserol. Autopsy has shown arterial plaques to be composed of fats, cholesterol, pus and urate.
I saw a foot autopsy picture and bejesus it looked like the tophus in the toe was covered in the same whitish-yellowish layer of what looked very similar to coronary arterial plaque.
So the protective device in the toe becomes the killer in a coronary artery…or ANY artery. When one of these infected plaques break in the foot we get a gout attack, when it breaks in an important artery we risk a lung or kidney embolism, an attack of phlebitis, a heart attack, or an occusive stroke.
Why would one expect uric acid to cause an inflammatory process in ONE part of the body and PREVENT an inflammmatory response in another? The immune system HATES uric acid because it is a poison and it hates it WHEREVER it finds it and the reaction/overraction of the immune system causes gout and abets heart disease.
Refrigerate if going to keep it more than a day. Starches ferment as readily as sugars and “fermented black beans” is a staple condiment in Oriental coking. Who knows though, maybe a llittle fermentation will improve the taste…PROSIT!
Good choice Wes.
My personal experience has been horrific interactions between clarithromycin and Lipitor…never again. But I have taken several Z-packs over the last years for terrible bacterial bronchitis and there was no interference with the Lipitor. Maybe the same could be said for azithromycin-colchicine as your pharmacist implied.
So perhaps azithromycin isn't as coactive as some of the other macrrolides. Personally, I think it is a wonder drug.
And of course for gout pain, I don't think ANYTHING approaches colchicine for effectiveness. I think those who don't see great results with colchicine are usually just taking too little.
Just send me the used beans and I'll keep my blender pureeing them 24/7. Could probably even smoosh then through a pasta press and make high protein high fiber spaghetti!
Black bean pie wouldn't fly though but maybe with enough sugar and whipped cream who knows?
Dammit…
I am at the center of the universe a mile from Times Square but 21 miles from WallyWorld and no car…$.89/lb. makes the cheapskate in me salivate. WW seems to be the only major discount store that doesn't want to be anywhere near New York City??????????? Go figger.
Wes,
First thought: take Aleve (naproxyn,) up to 800 mg./day, until a week after you are through with the Z-Pak. And then begin the colchicine if you need it.
A severe interaction between the macrolide and the colchicine is NOT worth the risk.
But another little dirty thought: the DANGER of the macrolide is that it prevents the liver from destroying the colchine so maybe a LITTLE colchicine will give a lot more relief than expected. THis is of course an IFFY proposition because it is hard to draw that line between just right and too much. But too much colchicine has a pretty good signature: murderous diarrhea.
If I were dosing myself, I think I would take up to 4 colchicine and see what happens. If no relief then I'd do the naproxyn.
How is your condition progressing that requires the Z-Pak?
I really think taking HALF a Z-pak is a terrible idea. Once started it should be finished to avoid a super rebound infection.
What is your basic treatment for tophaceous gout? Allopurinol, probenecid or BOTH?
Headusher,
Refresh our memeories on how much allopurinol you have been taking since August. Of course, as you know, control to 7.6 is not good enough to prevent crystal formation in joints and ligaments. A minimum you should strive for is <6.0
I don't buy organic…so I guess I have to call them INorganic beans.
My price yesterday was $1.29/lb (454 g.) for Vitarroz Frijoles Negros (black turtle beans.) Last month they had GOYA brand on sale for $.99.
We are having a pretty steep food inflation in the United States (in spite of government denials of the obvious) and these prices are all up about 50% over a year ago.
From trev: I just stress that many other studies keep noting these trends and risk factors but haven't yet come to a consensus on a solid link.
The evidence for the hyperuricemia-CVD link is there and it is solid evidence limited ONLY by the ability of schools and clinincs to fund the research and I could post page after page after of data supporting the strong connection but I am reminded of the pretty sollid evidence that existed iin the 50's that ciigarettes were deadly…we called them COFFIN NAILS as far back as my memory goes. But decade after decade passed during which the cigarette producers (aka cancer, heart disease, COPD, emphysema producers) kept saying “Yes but there's not enough evidence linking smoking with these disease. THere's no CONSENSUS.” And of course the oil companies claim no scientific CONSENSUS on global warming until the only glacier will be available as pictures in old Nation Geographic magazines.
I am not impressed by statements like “Yah, but that's only for women” or “Yah but that's only for blacks” or “Yah, but that's only for the elderly.” In my book that is obfuscation. Neither am I very impressed by advantages of uric acid that are demonstrable only in vitro (in a test tube or a petri dish.) But I am least impressed by claims that uric acid is somehow “an antioxidant” along with every other peddleable expensive nutritional supplement.
Remember, there is a financial penalty to be paid if hyperuricemia is llinked to diseases other than gout, especially heart disease and brain damage. And that is because the FIRST dietary promulagation, once the clear link is actually ADMITTED will be to eat far less meat and fish. The screams from the meat and fish producers will make Phillip Morrris' howling of the last 30 years sound like a cat's purr by comparison.
trev, I'm glad you started a new page on this. I was feeling guilty for cluttering up the other thread. Now we have a clear place to present the evidence on the proposition/debate: Resolved: “Hyperuricemia is a killer independent of gout. Yea or Nay”…or it's corollary: “Average levels of uric acid are beneficial to humans…Yea o Nay”
My position is prettyy stongly AYE, hypreuricemia is causative in heart disease and NAY, it is a poison and has no meaningfully useful function for humans. I think the evidence supports both these positions.
Ancillary,
Yes, I understand being stuck with that red color because sometimes this board has a mind of its own on formatting…once it gets a font or a color in its head there no doing anything about it. I've given up trying to battle it except for that occasssionally teeny font that occasionallly pops up on cut and pastes that is impossible to read without a strong magniffying gllass. Sometimes I just give up trying to do the paste because nobody will be ablle to read it.
{{wink}} I guess you are leaving it to me to do that dogwork in digging out those two Italian studies…I was hoping to pass the baton on that one.
Well, thank God you were not forced to endure a uric acid of 9.8 or even much higher as the weeks went on.
Yes, hyperuricemia is a kidney killer.
Please tell me your GFR. Please?
Amazing how fast your numbers shot up. Here's my conjecture: human kidneys excrete uric acid very poorly, damaged human kidneys excrete it very VERY poorly and once you started producing a normal amount without excreting much…BAM!
My reasoned guess is that you are more of an underexcreter rrather than an overproducer. What does your nephrologist think about a uricosuric like probenecid. (I have no clue on whether or not damaged kidneys will tolerate it but he should know.)
You probably have hypertension…if so make sure that you add losartan (Cozaar) to your regimen!
sueg,
I find indocin to be a far behind second best to colchicine to abort the pain of an acute attack. My problem with it was that it makes me dizzy and that sounds llike the WORST thing for anyone with any degree of dementia. First time I took it I almost fell down an escalator because things got so swirly.
Ask his doctor for a bottle of colchicine instead. How to take it is all over this forum.
Keep his infected foot raised as much as possible to help cut down the swelling…keep it warm.
Fred,
Losing the 25 pounds rapidly could have , let me get the word right, “emptied” some of the fat out of your pecs leaving saggy skin that is giving the IMPRESSION of breast tissue. Real gynectomastia can be boobs on a skinny man and then be very easy to diagnose as probably hormonal. For someone 350-375 I think it might be just illusion…just a little sag.
Yes losing weight fast liberates a lot of nucleic acids whose only route out of the body is conversion to uric acid. Continue the weightloss but know that you now have allopurinol blocking some of this conversion. I hope with further loss your man boobs but into hard pecs at 200-250 pounds with some serious bodybuilding…never too late to start.
So if youve had both TOES, then you definitely have gout but whether your current knee bout is due to gout or something else is hard to tell…knees are funny. With non response to colchicine maybe not gout. Elbow might be more likely.
But your steady treatment with 300 mg allopurinol and a visit to your rheumatologist is precisely correct. Test your uric acid again and if you see another 4 you are sliding into home free.
By my rough calculation youve taken 2 POUNDS of Vitmain C over the last 3 months. THis produces an extraordinarily acidic urine. Yes, just like taking 6 grams of aspirion a day, you will excrete coopiuos amounts of urate in acidic form…uric acid. You will be excreting it in an environment where it is extremelly insoluble.
Get your uric acid tested post haste and have a kidney ultrasound to make sure you arren;t depositing crystals.
Paids,
See a rheumatologist becasue a gout diagnosis from only a wonky knee is often problemmatical. A big red toe is easy, a bad knee that was formerly injured is a hard call to make. I know I have 2 damaged knees, one goes back to shredded cartilege 50 years ago caused by a gym coach who wasn't smart enopugh to be gym coach…if anyone can CONCEIVE of a person quite that stupid who was not actually a rutabaga in disguise.
It thus took me a long time, even in the presence of confirmed gout, to realize that when my knees acted up it was becasue they were “damaged knees” and not gout attacks. MY best evidence is that every time I've taken up running/jogging I am fine for about 3 weeks and then my knees start to scream at me. When I stop, in a couple weeks they go back to painless. That's not gout, that's repetetive stress pain in joints that won't tolerate any more stress.
Extraneous thoughts:
meta:
1. I checked back and I stilol have EDIT on my posts that are several weeks old…I Use I.E as my browser.
2. I am AMAZED that you can cook 7 ounces of beans in 2 liters of water and be able to drain off 1.5 liters of broth. Apparenly my beans are a LOT more absorbant than yours.
Trev:
No, I'm here just out of curiosity…I don't need any gout analgesics anymore but DO love pureed black bean soup and thus everything goes into the blender with spices and I enjoy a fine pureed black been soup “ala Cubana.” THis from an Austro-Russian!
I too am almost CERTAIN that BBB will have no effect on serum urate but I am scientist enought to say this is onlly a guess in the absence of someone actually doing the dogwork to find out for sure.
I for one in the presence of tested hyperuricemia would NEVER count on any analgesic to prevent active attacks no matter how “natural” or “unnatural” becasue hyperuricemia even without gout attacks is dangerous and quite possibly life threatening. It MUST be controlled.
Fred,
(I would normally have tried using your post and putting my comments in line by line but I'm afraid our primitive little bulletin board might make a mish-mosh so I;ll do what I can.)
Firstly, your doctor is making a pig's breakfast of prescribing allopurinol. Almost nobody goes to a 600 mg,/day dosage without a LOT of care, certainly not in any kind of quick progression of 100, 200, 600 over a matter of a couple weeks. Once allopurinol is started it is NOT to be stopped during an attack and thrashing around to this super-high dosage and then pulling you off is malpractice. A logical treatment is something like 300 mg/day FOREVER with MAYBE an adjustment every year. Frequent dose changes are going to cause more attacks than prevent.
Gynectomastia (man boobs): I am not an expert here but I think the likely cause, if they have come on recently, is the STEROID treatment, presumably prednisone? that you are taking. The drug of choice for an acute gout attack causing inability to walk is COLCHICINE, taken during one day at a dosage of 2 pills and then followed up by one an hour for 11 more hours…15 if necessary or until exctreme diahrrhea or pain relief intervenes. Do this in ONE day and don;t take more than 2 or 4 pills the next day if you are satill in pain. THe diarrhea can be quite vicuious. Diddling with one or two pills a day during an acute attack is useless.
If you take the colchicine the right way, there is no heed for the huge doses of ibuprofen (I'm amazed you still have a stomach!
) Do NOT take aspirin except for a 75 mg/day regimen if you take it for your heart.1. and 2. There is no need to take a divided dose of allopurinol, its metabolites stay active for several days so taking one dose a day of 300 mg. is precisely equal to taking 2 x 150 mg. Yes, huge doses of allopurinol will bring blood levels down to 4.0 very quickly…alas that sometimes frees up stored uric acid from joints to revisit other sites and cause further grief.
3. Do not stop the allopurinol during a gout attack. The rule is don't START during one, but NEVER wstop.
4. Take 300 mg. allopurinol in a single dose…that's enough.
5. No man-boobs that I;ve heard about from allopurinol. Are you a body builder on any OTHER anabolics?
6. Your doctor IS trying but he sounds out of his league here and is thrashing around with try thi-try that. See aa rheumatologist.
Addendum: Have you had the classic TOE? Are YOU certain of the gout diagnosis (never mind the doctor.) Remember colchicine is somewaht diagnostic. If it doesn;t work in the BIG dose, then let the rheumatologist make a final determination…perhaps with a joint fluid bioply during an attack.
Re-addendum: You might be amazed at how rapidly you can abort the worst attack with colchicine done right.
WHEW!
So the DOSE is 600 mils from the 2 Liter start volume and the 7 ounces of beans. Are we on the same page?
For we americanos, that's about 20 ounces or a 2 1/2 cupfuls.
N.B. I'm not praising the method nor damning it…just curious. I have never tried it except that pureed black bean soup is on of my favorite lunches, so in a sense I get a LOT of it.
Hmmm, With Khellin and carveldilol is there some issue with heart failure? THe piperizine is a pretty strong base so it makes sense with gout where you want to neutralize as much acid as possible.
(Carvedilol is an alpha AND beta blocker generally used to ease the strain on the heart without too much diminishing its pumping ability. It's not usually a first line antihypertensive but rather one of the bigger guns. Beta blockers interfere BADLY with my sleep or I would use one regularly because diuretics, while the do the job of BP control admirably, cause gout issues.)
I guess most drugs are always a give and take.
I chatted extensively a while back with one of your countrymen on another board and I was envious of his ability to walk into any pharmacy without a prescription and get anything he asked for! My DREAM is not to have to argue with doctors to get what I want!
I'm glad your friend has tendonitis rather than gout but there is often a lot of overlap between these two conditions. A couple more SUA's is a good plan just to be on the safe side.
Meta,
Your recipe calls for boiling 7 ounces of beans in 2 liters of water. From experience I know the beans absorb a lot of water and boiling for 90 minutes evatorates a good deal.
When you are done and strain the concoction, how much liquid (BBB) do you get from it?
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You are not paranoid but perhapps a bit hypervigilant.
Any one of a hundred viruses could cause your symptoms.
funandsmile,
Don't necessarily assume that starting allopurinol WILL bring on attacks, it just MAY; I never triggered any and I went right onto 400 mg.
To lower the chances you could take one or two colchicine every day WITH the allopurinol for the first month or two.
Colchicine will NOT reduce tophi, nor will it lower uric acid. It is STRICTLY for pain relief in aborting an acute attack.
Richard, try to encourage the draining, with massage and hot soaks if not too painful and make sure that your specialist takes a sample of the fluid to make sure it is urate. The more you get out before it seals over the better for you in the long run.
Diclofenac is not a good pain reliever for gout because it retains uric acid.
Have yours tested ASAP. If it runs over 7.0 go on allopurinol IMMEDIATELY, 300 mg. The odds are EXTREMELY hight that you will never suffer a single side effect from the drug. You will need regular blood tests to make sure your uric acid is staying below 6.0. or even 5.0.
Untreated gout will kill you if you live long enough.
How does your father treat HIS gout?
Vitamin C is NOT a substitute for allopurinol. Since it is an extremme urine acidifier I think it is detrimental to gout sufferers but that filies in the face of the Pauling theories that Vitamin C cures EVERYTHING.<rolling eyes>
It sounds like your doctor will allow no alternatives to Uloric…have you asked him why he thinks it's Uloric or nothing.
(I CAN think of one.)
Have you asked him to explain WHY what you suffered was not an attack of rhabldomyolysis. Rhabdo IS the destruction of the kidneys when flooded with a load of poisons. If not what then WAS it?
I also would find another doctor.
I see numbers indicating discontinuation of allopurinol due to side effects in the range of 3% or less.
But probably FAR higher numbers represent people who just DON'T want to take a drug forever. And these people have more gout attacks and go back on and then off…
DIURETICS CAUSE GOUT…thiazide diuretics are the worst of the lot.
What is effervescent or effervescent uricosuric?
What country are you being treated in polaris?
Is it gout or not? Cannot tell for sure. Perhaps you will have to wait for more data. With uric acid levels of 3, it is virtually impossible to precipitate crystals.
If you DO need a diuretic I recommend a switch to furosemide if you are on thiazide…no guarantees but furosemide retains less urate. Ask for losartan also.
